A Neck Boil That Almost Killed a Legendary Poet? Doctor Li Dongyuan’s Huanglian Xiaodu Yin (Coptis Dispersing Toxicity Decoction)
Opening scene: a deadly boil on the neck of the greatest writer of his age
💬 Note from Doctor Luo: Today’s story is about Yuan Haowen — the foremost literary figure of the Jin-Yuan period. If you only hear the name, you may not recognize him, but almost every Chinese person knows one of his lines: “Ask the world, what is love, that it makes life and death mutually pledged?” That is his (it comes from his famous ci lyric, “Mound of Wild Geese” — written when, on his way to the imperial examinations, he watched a hunter shoot down a wild goose; the mate circled overhead, crying mournfully, then dove headfirst to the ground and died for love. Yuan Haowen sighed that “the fidelity of wild geese surpasses that of human beings,” bought both geese, buried them in a mound, and wrote this lyric. Later, people who did not know its origin altered the line to “makes living people pledge life and death” — but the original was written about a goose). In his later years, this great writer developed a boil on the back of his neck that nearly killed him — until his close friend Doctor Li Dongyuan stepped in and turned the tide with a single dose of medicine. What makes it rarer still is that the entire course of treatment was recorded in Yuan Haowen’s own hand — a man of letters writing up a medical case, with a detail that leaves you in awe.
How did this case survive? After Yuan Haowen wrote it up, Luo Tianyi, Li Dongyuan’s disciple, included it in the book he compiled for his teacher (Dongyuan Shixiao Fang — Effective Formulas from the Dongyuan Studio), which is how we can read this vivid record of the whole treatment today.
💬 Note from Doctor Luo: First, a word about the relationship between Yuan Haowen and Doctor Li Dongyuan — it was a friendship of life and death. When the Mongol army besieged the Jin capital (Bianliang), the two of them were trapped in the city together and witnessed the fall of the Jin dynasty and the suffering of the people firsthand; after the city fell they were both marched off to Shandong before each finally made his way home. After the Jin dynasty fell, Doctor Li Dongyuan settled in Zhending (present-day Zhengding, Hebei) to practice medicine, and Yuan Haowen came to visit him — which is where this story takes place.
How the illness began: a small boil, no pain, no itch — nobody gave it a thought
In the wushen year (c. 1248), Yuan Haowen said of himself: “Because I drank too much wine” — the wine had flowed too freely. A great writer visiting a friend’s home, fine wine brought out to honor him, and before he knew it he had drunk too much.
On the seventeenth day of the ninth month, Yuan Haowen arrived in Zhending. That day he discovered that below the brain, above the nape (the back of the neck, close to the head) a small boil had appeared — no pain, no itch. Everyone said it was just a boil, and Yuan Haowen thought nothing of it. That night he stayed at the home of his good friend Shanfu.
Two days later, it began to ache slightly. Around this time he met the man everyone called the “national physician,” Li Mingzhi — that is, Doctor Li Dongyuan (personal name Gao, style name Mingzhi). They exchanged pleasantries happily, the boil was hardly painful, and so Yuan Haowen did not mention it. Later, “altogether he saw him three times” — he met Doctor Li Dongyuan several times, at several gatherings, and never once brought it up, thinking nothing of it.
Two more days passed, and things changed: the back of his neck went numb — numb but not swollen, the toxic force beginning to spread outward, the poison starting to rise. When Yuan Haowen told everyone, they said: there was a certain Commander Liu here in town — he died of exactly this kind of nape carbuncle!
Bad news: a local commander died of this very illness
💬 Note from Doctor Luo: Let me explain what ju (deep-rooted carbuncle) means. In antiquity, terms like chuang (sore), ju (deep carbuncle), yong (superficial abscess) and zhong (swelling) were distinguished very carefully: ju specifically refers to a sore that does not look large on the surface — the skin may not even change color — yet is extremely dangerous, with the poison building up deep inside. This Commander Liu died of a nape carbuncle. Never underestimate such things — in ancient times, with poor hygiene, a boil really could kill you: Fan Zeng, the “father-advisor” of Xiang Yu, finally died of a boil on his back; and our own famous Doctor Xue Lizhai (the great Ming dynasty physician) also died of an unhealed back boil in the end. That is why the ancients treated “sores, carbuncles, abscesses and swellings” with such dread.
Yuan Haowen’s heart sank at this news: the previous holder of this post died of this boil — so what about mine? And he began to ponder it seriously.
Within three days, the pain erupted in full force, and at night he could no longer sleep. By the twenty-second day (counting from the seventeenth, when the boil first appeared), Yuan Haowen went to see the physician in town who specialized in sores and swellings.
The small-town doctor’s plan: wait eighteen days for the pus, then rest four months
The first physician prescribed a formula called Wu Xiang Lian Qiao Tang (Five Aromatics and Forsythia Decoction) — the “five aromatics” being various fragrant herbs (ding xiang (clove), mu xiang (costus root), she xiang (musk) and so on, five of them), plus lian qiao (forsythia) — the idea being to use fragrant qi to dispel the murky, filthy qi. He told Yuan Haowen to come back the next day.
The next day, the physician — not fully confident himself — invited a colleague from the same lineage to examine the patient together. The two of them looked, and both said: “It is a ju (deep carbuncle).” But they also said the illness could not be treated quickly — one had to wait eighteen days for it to suppurate little by little; once the pus formed, either with medicines or by lancing it with a stone needle, drain the pus out; then “in three months it may level out” — three months to settle, and four months before he could fully recover.
💬 Note from Doctor Luo: Were the two physicians talking nonsense? Actually no — this is the traditional approach: wait for suppuration, drain, and let the wound close slowly. When I was a child, my own father had a boil — a duikou sore on the back of his neck. It looked small, but when you felt it, the root went deep. My mother applied a Ba Du Gao (Toxin-Drawing Plaster) to make it suppurate; later he went to the hospital, where the doctor packed the cavity every day with medicated cotton strips, and it healed only slowly — leaving a pit that took a long time to fill in. So from childhood I kept wondering: the poison ought to be drawn outward. Around middle school I came up with a method: crush some Liu Shen Wan (Six Spirit Pills), moisten with water or vinegar, and smear a ring around the boil, leaving an opening in the middle — usually within one night, the boil dried up and died! In university, when male classmates in the dormitory corridor got boils on the backs of their necks or lower backs, they all came to me — and it worked every time. Later, reading the ancient texts, I learned this method is called the “encircling method” (wei gu fa) — a standard external-medicine technique of old: used when the poison has just begun to stir, with slight swelling and slight pain; you ring it all around, leave a gap in the middle, and keep the poison from going inward.
Yuan Haowen, hearing he must wait four months, grew even more alarmed. He said: “I seem to remember reading in medical books that ‘when a sore produces pus, nine of ten die’” — once true pus appears, nine out of ten patients die. If I follow these two gentlemen’s plan, then I “will have only the regret of waiting with folded hands for death” — I might as well wait to die. He thought it over: only Doctor Li Dongyuan could save me now!
Doctor Li Dongyuan arrives: chatting as if nothing were wrong — “With me here, you have nothing to fear”
Yuan Haowen hurried to the home of Adviser Han Yanjun (a friend who served as a staff officer) and asked him to bring Doctor Li Dongyuan.
💬 Note from Doctor Luo: Here is a delightful detail — Yuan Haowen knew Doctor Li Dongyuan so well, and later wrote that he had watched Doctor Li Dongyuan cure boil after boil, all of them miraculous — so why did he not ask him to treat the boil from the start? I pondered this for a long time while writing up this case — but the mind of a man of letters is strange; one cannot guess it, and only he knew the answer. In any case, this time he was truly frightened, and so he summoned Doctor Li Dongyuan.
When Doctor Li Dongyuan arrived, Yuan Haowen thought he was about to die, frightened out of his wits. But after examining him, Doctor Li Dongyuan chatted and laughed as usual, as if nothing were wrong, and told him: “This sore is certainly vicious” — it was indeed a vicious sore (later, writing up the case, Luo Tianyi also called it a vicious sore, by no means a light illness) — “but with me here you have nothing to fear — I will treat you.”
Then Doctor Li Dongyuan analyzed the cause: how did this illness come about? “The change of rich food” (gao liang zhi bian) — eating too richly and drinking too much, the qi and blood of the internal organs begin to alter, accumulating phlegm-heat inside. The Wu Xiang Tang (Five Aromatics Decoction) he had drunk earlier was warming in nature and should not have been taken — the heat poison was now trapped inside. By now the carbuncle had dragged on for eight days. Doctor Li Dongyuan settled the treatment plan: “First use the fire-attack strategy, then use medicine.”
Fire attack first: moxa cones the size of jujube pits, burned a hundred cones
What was the fire attack? After noon (after lunch), Doctor Li Dongyuan took large moxa cones — the size of jujube pits — and used the moxa fire to attack the sore, “up to a hundred cones” — burned over a hundred, until Yuan Haowen began to feel pain; only then did he stop and write the prescription.
💬 Note from Doctor Luo: Burn the sore directly with moxa cones? Can that work? Yuan Haowen’s record is not detailed — in other places in Doctor Li Dongyuan’s books, the moxibustion method is to slice garlic (especially single-clove garlic) and lay the slice on the sore, then place the moxa cone on the garlic slice and burn it (garlic-separated moxibustion). If you moxa directly following Yuan Haowen’s bare record, you would burn the flesh to a crisp. So why moxibustion first? Because this kind of carbuncle means the qi and blood are not circulating: the area feels numb, the pain is not fierce, and there is no red, hot swelling — all signs that the poison is trapped inside and cannot get out. The moxa first opens up the qi and blood, so the poison can vent outward. That is the key logic of “moxa first, medicine after.”
After the moxibustion, Doctor Li Dongyuan made his pattern differentiation: the sore sat on the foot taiyang bladder channel (not dead center — it lay to one side, much like the location of my father’s duikou sore back then). He took the pulse: stringlike and tense, surging, large and forceful when pressed deeply — meaning the heat had begun to come out, and the heat force was considerable.
Persuading a scholar with the Huangdi Neijing: the reverse treatment and the frozen-vegetable story
To treat a man of letters like Yuan Haowen, writing a prescription was not enough — he might not believe it. So Doctor Li Dongyuan first quoted a long passage from the Huangdi Neijing (Inner Canon) to explain the principle thoroughly: “One must subdue what governs the illness, and first trace its cause. The beginning may be the same, the end different — it can break accumulations, it can dissolve hardness.”
💬 Note from Doctor Luo: This is the reverse treatment (fan zhi fa) taught by Qi Bo in the Neijing: “Heat is treated with cold; cold with heat; blockage with blockage; discharge with discharge.” What does it mean? Usually, when you see a heat pattern you use cooling herbs; but sometimes the body rejects cooling herbs, or they provoke the illness into erupting even more violently. In such cases you do the opposite — treat a heat pattern with heat methods, a cold pattern with cold methods — but the purpose is always the same: find the root of the illness and regulate it, and ultimately cure it. An analogy: a piece of frozen vegetable dropped into water thaws very slowly in hot water; rinse it with cold water, and the ice melts away quickly, bit by bit. Doctor Li Dongyuan’s treatment was exactly this: to the eye it was a heat pattern, yet first he gave moxibustion (a heat method) to open up the qi and blood; and even the medicine that followed was not purely cold and cooling — warming, blood-activating herbs were added as well. Whether Yuan Haowen fully understood this, who knows — but that is indeed how Doctor Li Dongyuan treated him.
There was another layer of reasoning: “One must first honor the qi of the year and not violate heaven’s harmony” — it was now the ninth month, so sweating (the diaphoretic method) was out; autumn was approaching, so the purging method was out too. One must adjust according to the movement of the seasons. He also said “knots should be scattered” — fine, if there is a lump, help scatter it — but “saltiness softens” did not apply to Yuan Haowen — because he was somewhat chilled, and this sore was an attack from both sides: heat stored within, cold assaulting from without. Salty herbs would not suit a chill.
💬 Note from Doctor Luo: Doctor Li Dongyuan’s treatment principle was — bitter-cold herbs as the sovereign, sweet-cold as assistants, acrid-warm herbs as channel-guiding envoys; sweet herbs to boost the original qi and harmonize the blood vessels; dampness-draining herbs to guide out the wine-dampness (he had drunk too much, so dampness was heavy inside); “support autumn and winter to boost qi and drain fire” — the fire inside you is too great, yours is the “spring-summer configuration,” and I will use medicine to move you into the “autumn-winter configuration” (I explained this “configuration” theory yesterday); and finally herbs that enter the affected channel to harmonize the blood — the disease sits on the foot taiyang bladder channel, so wind herbs that enter that channel are used to harmonize the qi and blood. That writer Yuan Haowen was truly remarkable — whatever Doctor Li Dongyuan explained once, he could largely remember, and his record is close to complete; when Luo Tianyi collected the book, he only needed to tidy it up slightly.
The prescription: Huanglian Xiaodu Yin — bitter cold to drain fire, wind herbs to unblock
The formula was written out, named Huanglian Xiaodu Yin (Coptis Dispersing Toxicity Decoction). First, the sovereign-herb group: huang qin (scutellaria root), huang lian (coptis rhizome), huang bai (phellodendron bark), sheng di huang (raw rehmannia root), zhi mu (anemarrhena rhizome) (the zhi mu had been prepared with wine).
💬 Note from Doctor Luo: Huang qin, huang lian and huang bai drain heat — heat of the heart and lungs, heat of the upper, middle and lower burners alike; sheng di huang drains heat, cools the blood and nourishes yin. This is the “supporting autumn and winter” mentioned earlier — changing your “spring-summer” heat configuration and moving you into the “autumn-winter” configuration. The doses are all small: huang lian 1 qian (about 3 g), huang qin 5 fen (about 1.5 g), huang bai 5 fen (about 1.5 g), sheng di huang 4 fen (about 1.2 g), zhi mu 4 fen (about 1.2 g). Modern doctors treating a boil will throw in 30 g of heavy herbs at the drop of a hat — the ancients actually used small doses.
Next came the wind herbs: qiang huo (notopterygium root), du huo (pubescent angelica root), fang feng (saposhnikovia root), gao ben (ligusticum rhizome).
💬 Note from Doctor Luo: This is the greatest hallmark of the Li Dongyuan school — expert use of wind herbs. Wind herbs scatter wind pathogens, drain dampness and unblock the channels and the qi and blood; among them, gao ben is the channel herb of the foot taiyang bladder channel itself — it enters that channel directly and opens up its qi and blood. There are many wind herbs in the formulas of these Jin-Yuan masters — that was a signature of the age. The theory behind it is called “wind can overcome dampness” — it comes precisely from the Four Great Masters of the Jin-Yuan period. Our own Professor Zhao Shaoqin of Beijing University of Chinese Medicine, when treating kidney disease (with heavy dampness inside), opened with fang feng, jing jie (schizonepeta), bai zhi (Dahurian angelica) and du huo. When I studied herb-dispensing back then, I could weigh out three grams, six grams at a glance, and the pharmacists at Zheng’an Chinese Medicine were astonished: “How do you hit the weight so exactly?”
Then came jie geng (platycodon root) — to carry the medicine upward (the disease sits up high, so the medicine must travel up); dang gui wei 4 fen (about 1.2 g, the tail rootlets of Chinese angelica) — the head of dang gui stops bleeding, the body nourishes blood, and the tail breaks up blood stasis; here the qi and blood of the sore are congested, so it is used to scatter them; lian qiao 4 fen (about 1.2 g, forsythia fruit) — resolves toxin, with the strongest knot-dissolving action.
Then there were huang qi (astragalus root), ren shen (ginseng) and gan cao (licorice root) — three sweet herbs — to support the upright qi and boost the original qi: when the qi of the viscera is insufficient, the pathogen cannot be expelled, so one must regulate the viscera and push the toxin outward at the same time. Add fang ji (stephania root) — to drain dampness outward (too much wine, damp-heat inside); chen pi (aged tangerine peel) — to keep the huang qi, ren shen and gan cao from stagnating inside and to help move the qi; su mu (sappan wood) — paired with dang gui wei to invigorate the blood and break stasis. This formula is remarkably complete: bitter-cold to resolve toxin, acrid-warm to unblock, and qi-tonifying to push the toxin out.
Doctor Li Dongyuan’s three methods for treating sores: support the interior, unblock, and move the ying and wei
Doctor Li Dongyuan himself summarized — when treating sores and swellings, there are three methods, and you must understand them all:
💬 Note from Doctor Luo: First, support the interior (tuo li) — you must support the upright qi; do not see a boil and go all-out resolving toxin — that will not do; the qi of the viscera must be topped up. If the viscera are out of order and the toxin cannot come out, regulate the viscera while pushing outward; if the external pathogen is moving inward, then heavily tonify the qi of the viscera to push it back out. Second, unblock (shu tong) — the qi and blood are certainly stagnant; wherever there is a sore there is stagnation, and you must know how to open it. Third, move the ying and wei (xing ying wei) — if the pathogen is stuck halfway between the exterior and the interior, move the qi and blood and split up the pathogen. Look at the whole formula — everything is here: the qi-tonifying group (huang qi, ren shen, gan cao), the unblocking group (wind herbs, chen pi), the dampness-draining group (fang ji, wine-prepared zhi mu) — all in one prescription.
Once the theory was fully explained and the formula clearly laid out, Doctor Li Dongyuan also forecast the results in advance: after you drink this medicine, the sore should stop hurting; your heart will suddenly feel light, and at once your energy will surge and your appetite will grow, and your body will slowly become healthy. Yuan Haowen listened — every citation was from the Huangdi Neijing, real learning indeed! Only then was he willing to take the medicine.
One dose down: the swelling subsided by 70–80 percent — and the scholar panicked again
He took the medicine, following the method Doctor Li Dongyuan had given. After the dose he felt dizzy and drowsy, lay down and slept, and did not wake until the sun was up — he reached back and felt: the swelling had subsided by 70–80 percent!
💬 Note from Doctor Luo: Notice — here is something very amusing. Yuan Haowen wrote it himself: the boil had shrunk, and this writer’s mind was full of schemes: the boil shrank — then where had the poison gone? Could it be about to erupt from the front — from his mouth? That would be terrible — even worse! You see, treating a man of letters is exhausting; they scheme too much. So he hurriedly summoned Doctor Li Dongyuan again: “Has my illness turned serious?”
Doctor Li Dongyuan looked, and “exclaimed with delight”: your boil is leveled — it has drawn back in! From now on count the days on your fingers — within five to seven days it will scab over, and then you may go out again.
The three verifications: appetite good, legs strong — and one “unspeakable good thing”
Doctor Li Dongyuan left. Three days later, a “change of dream-emission” suddenly occurred (Doctor Luo Dalun’s judgment: the change recorded in the original text most likely refers to nocturnal emission).
💬 Note from Doctor Luo: What is nocturnal emission? It is a sign of flourishing qi and blood and full essence — the illness is improving and the upright qi is recovering. But Yuan Haowen did not see it that way! He felt his essence had leaked away in a great discharge — a portent of death! Yet such a thing was too embarrassing to tell anyone — “there was no one he could tell.” Just then Doctor Li Dongyuan arrived.
The moment Doctor Li Dongyuan saw him, he teased him: brother, after taking my medicine you should have shown three verifications (three signs that the medicine worked). Why have you not told me? Let me check for you — the first: these past two days, has your appetite been exceptionally good — can you eat a lot? Yuan Haowen thought: yes, yes, exactly — I can eat! The second: in the past your legs and knees were weak and you could hardly walk — are your legs and feet strong now? Indeed they were! — with the qi and blood flowing, the upright qi replenished and the heat pathogen gone, strength naturally returns. The third: “Last night — did you have a dream-emission?” Why did you not confess to me?
Yuan Haowen wrote it himself: “I laughed at him, and in the end did not tell him about it.” — I chuckled, and never told Doctor Li Dongyuan about that matter to the end.
💬 Note from Doctor Luo: He wrote all of this himself — see how entertainingly this writer recorded it, setting down all his little schemes and little embarrassments, so vivid that reading it hundreds of years later we still smile.
Scabbed over in fourteen days: riding through the street on horseback, the whole town rejoiced
By the twenty-ninth day, the pain in the sore had completely stopped. The scar from the moxibustion (even through garlic it had left a scar) — the scab had fallen; inside, a scab had formed too — recovery was well under way.
Back then, the townsfolk had watched Commander Liu suffer through this illness (and die of it); when they heard Yuan Haowen had contracted it, they were terrified and prayed silently: please, may he not die too.
On the seventeenth day of the tenth month, Doctor Li Dongyuan invited Yuan Haowen to his home as a guest. Yuan Haowen rode his horse through the street, and recorded it himself: “People saw me and some were so happy they could not contain their joy” — everyone saw him riding out on horseback, and were happy past all restraint — Yuan Haowen was well at last!
💬 Note from Doctor Luo: Yuan Haowen counted it himself: from the day Doctor Li Dongyuan administered the medicine to the final closing of the wound and the falling of the scab — only fourteen days in all! A truly astonishing result.
Yuan Haowen’s verdict: in all his life he had seen only one physician like this — Li Dongyuan
Yuan Haowen reflected: in the past, in Liaocheng (in Shandong), he had watched Doctor Li Dongyuan treat all kinds of sores for others — all cured within a dozen or so days, even the most severe — but none of those had shown him anything as truly miraculous as this.
💬 Note from Doctor Luo: He said: treating a sore is hard to begin with, and treating a sore on the brain and back is especially hard; curing it is already difficult, but even harder is this — he could explain the principles of the cure to me so clearly: quoting the Huangdi Neijing to make the theory plain, explaining exactly how each herb works, describing the symptoms precisely, and even forecasting exactly what changes would follow. That is the hardest thing of all. “A physician of this caliber — in my whole life, Yuan Haowen has seen only one: Li Dongyuan” — this was the “national physician,” and of course he was.
Because the record came from Yuan Haowen — the greatest writer of the age — it carries special weight, and so this case has come down to us. Yuan Haowen added: in a later year, returning from Jinan, he caught cold too severely — so badly that his qi ceased and he nearly died; he called for Doctor Li Dongyuan, who gave one dose, cured him at once, and brought him back from the dead. So he promised: one day he would write a biography of Doctor Li Dongyuan.
Later, when Doctor Li Dongyuan passed away, Luo Tianyi, compiling his teacher’s works, indeed asked Yuan Haowen to write a preface — and Yuan Haowen wrote a splendid one. The friendship of these two men has come down to us through the centuries.
💬 Note from Doctor Luo: Because this case was recorded by a man of letters, the whole process is extraordinarily detailed — from it we know exactly how Doctor Li Dongyuan treated illness, what his thinking was, what the full course of treatment looked like, and how good the results were. Most other cases are very brief, recording only the outcome without the process; but with a case like this preserved, we know: Doctor Li Dongyuan’s treatments were highly effective, and in his own time he was indeed regarded as a national physician. A little every day, getting to know these masters bit by bit — if we can learn something that helps us, that is good.
The original case is from Dongyuan Shixiao Fang (Effective Formulas from the Dongyuan Studio), chapter on sores and swellings — recorded in Yuan Haowen’s own hand and compiled by Doctor Luo Tianyi; the commentary is based on public lectures by Doctor Luo Dalun (PhD in TCM Diagnostics, Beijing University of Chinese Medicine).