Flogging Wound Won’t Ulcerate and the Pus Is Thin?

Patient search terms: beaten injury / external injury / wound not healing / wound not growing new flesh / wound turning black / thin watery pus / wound not closing / stagnant blood / chest blockage

Medical terms: flogging wound · external injury · traumatic injury · skin ulcer · deficiency of qi and blood · blood stasis

A Ming-dynasty “spanking” was far worse than you can imagine

Today’s case comes from Doctor Xue Lizhai (薛立斋, also known as Xue Ji), director of the Imperial Medical Institute in the Ming dynasty — and it concerns a type of injury that was unique to the old world: the flogging wound.

💬 Note from Doctor Luo: What is a flogging wound? It’s the injury you get from being beaten with a board. In the old days, if you made a mistake, you were given a thrashing — laid over and hit on the buttocks, smack after smack. It easily split the skin, and it easily caused deep internal damage as well. Treating flogging wounds was a regular job for the surgeon. And there was a special category called ting zhang — the imperial flogging: the emperor orders the beating. You criticized the emperor, you defied the emperor, the emperor gets angry — drag him out and give him twenty boards. That was unbearable, and it really could kill. In every dynasty the imperial flogging was brutal; in the Ming dynasty it was brutal enough to beat ministers to death on the spot.

So who was the man who took the beating? Wen Yonghui, an official in the Ministry of Justice. The reason he was beaten is a long story — it starts with Emperor Zhengde, Zhu Houzhao (朱厚照).

The patient: he told the emperor not to go on holiday — and got the board

Zhu Houzhao was a fascinating emperor. He built himself a “Leopard House” — a private playground where he kept fierce animals and gathered beauties from across the empire. But he was not muddle-headed on the big things — when the Mongol prince came raiding, his civilian ministers begged him not to lead the army personally, so he simply changed his name to “General Zhu Shou” and rode out at the head of the troops himself, routing the Mongols so thoroughly that the border stayed quiet for decades.

💬 Note from Doctor Luo: That was this man: not confused about the big matters, unable to control himself on the small ones. After he took the throne, the mid-Ming civil service had grown into an enormously powerful bureaucracy, and the emperor found himself hemmed in. Zhu Houzhao used his eunuchs — the famous “Eight Tigers” — to fight the civilian officials. The southern tour was one such battle: he wanted to travel south for pleasure, and the ministers dutifully remonstrated — you can’t go, it costs a fortune, it’s bad for the country. The emperor was furious: whoever speaks up again gets the board! More than a hundred ministers were flogged for their remonstrance, and eleven were beaten to death on the spot — even a man like Wang Yangming was flogged at that time.

Our Mr. Wen Yonghui of the Ministry of Justice was in that group: he knelt before the palace and urged the emperor not to tour the south — and for that, he was flogged.

Dead flesh that refused to ulcerate

Some time after the beating, the bruises had actually begun to disperse — but the flesh that had been beaten to a pulp had turned bad. The color had changed, gone black and dusky — and still it would not break open. That was the problem.

💬 Note from Doctor Luo: Notice this. The flesh had changed color, clearly dead flesh — and yet it wouldn’t split open. What had been used? Tuo li herbs — medicines that push outward, that “support and drain” the poison to the surface. A little bit of ulceration happened, but the pus that came out was thin and light-colored. That’s a red flag.

Doctor Xue Lizhai’s verdict: “Only a large dose of ginseng and astragalus can restore it”

Doctor Xue Lizhai examined him and delivered a judgment of eight characters: “This is deficiency of qi and blood.” He explained: in ordinary surgical illness, if the pus is thick and clotted, that’s a good sign; if the pus is thin, watery and pale, that’s not good — why? The qi and blood are insufficient.

💬 Note from Doctor Luo: So Doctor Xue Lizhai said — “only a large dose of ginseng and astragalus can restore it.” At this point you absolutely must supplement the upright qi, pile on the great tonics — ren shen (ginseng), huang qi (astragalus) — and build the qi and blood back up to full. Only then will it work. Mr. Wen knew medicine himself, and he asked: won’t ginseng and astragalus make me bloated? Doctor Xue Lizhai said: never mind that — you must take them! And he made him take them.

The turning point: from “appetite improving” to “pus turning thick” — the upright qi came home

After taking the medicine, his appetite improved a little. Doctor Xue Lizhai then increased the tonics, and his food intake grew day by day. At that point the dead flesh began to break open, and the pus turned from thin to thick. Treatment continued, new flesh gradually grew inside, and he was well.

💬 Note from Doctor Luo: This whole process is the story of the upright qi coming back. It’s the same principle as with any boil: if the skin around a sore is pale, even black and dusky, without that red, swollen, hot feeling — that is not a good sign. It means the upright qi is too weak to push the evil qi outward; no “battle” is being fought at the site, and the toxin can easily sink inward (nei xian). Weak upright qi plus inward sinking easily produces a critical condition.

Why is suppuration actually a good thing? Outward is “with the flow,” inward is “against it”

What should normally happen? The illness should move outward — normal suppuration, the pus draining away. That process of forming pus is really the body’s tissue fighting the local infection, fighting the external evil; pus is the pathological product of that battle.

💬 Note from Doctor Luo: So pus is not the enemy. Forming pus is a good sign, and the thicker the better — the battle is being carried outward, and in the end the upright qi drives the evil qi out. That’s called shun, “with the flow.” Going inward is called ni, “against the flow” — and that’s bad news. Trauma wounds work exactly this way. Keep this principle clear.

The same batch of flogged officials: over a dozen cured the same way

Doctor Xue Lizhai added that he also treated Hanlin scholar Jiang, the Ministry of Personnel officials Yao, Wang and Zheng, the Ministry of Personnel officials Li, Chen and Jiang, and the two Ministry of Justice officials Nan and Wu — a whole crowd, all flogged alongside Wen Yonghui for urging the emperor not to tour the south, and all cured by Doctor Xue Lizhai.

💬 Note from Doctor Luo: The treatment was the same for all of them: first dissolve the stagnant blood, then use herbs that drain and support to push the pus out, meanwhile strengthening the upright qi — and in the end all recovered. Doctor Xue Lizhai said such wounds must be treated by tonifying the spleen — why? When you’re being beaten you scream at the top of your lungs, and screaming injures the qi; you grit your teeth against the pain, and enduring pain injures the blood — both qi and blood end up depleted. What’s more, these were scholars who never exercised; their qi and blood were already insufficient. Where is the injury worst? The spleen is the first to suffer — the spleen governs the muscles (pi zhu ji rou). The muscles were slapped and beaten, the spleen qi was damaged, so they lost their appetite, ate less and less, and the qi and blood grew thin. That’s why the spleen had to be strengthened — only as the flesh gradually grows back can the wound finally heal.

Three iron rules for external injury: clear the stasis first, then strengthen the upright

Doctor Xue Lizhai also summarized the principles of treating trauma: if there is stagnant blood, first disperse the stagnant blood; once the stasis is gone, strengthen the upright qi — tonify qi where qi is deficient, nourish blood where blood is depleted.

💬 Note from Doctor Luo: The order of these two steps cannot be reversed. If there is stasis and you don’t clear it but go straight to tonifying, the more you tonify the worse it gets — the stasis is blocking the way, and all the tonified qi and blood pile up against the obstruction. On the other hand, if the stasis is cleared but the upright qi is still weak, and you keep on pushing and poking outward — that’s wrong too. At that point you must switch to supplements and build the upright qi up. Clear the stasis first, strengthen the upright second — that is the master outline of trauma treatment.

The secret remedy in reserve: child’s urine — and Doctor Xue Lizhai’s own story

Doctor Xue Lizhai told of one special situation: tong bian — literally “child’s urine,” the urine of a young boy. He said that one year, traveling on official business through Juyong Pass, he came upon an overturned cart. Seven people lay injured on the ground, and one had not even regained consciousness. Doctor Xue Lizhai quickly had a nearby child brought over, took the urine while it was still warm and poured it down the man’s throat — and in the end all seven were saved.

💬 Note from Doctor Luo: Doctor Xue Lizhai himself had once been crushed by a heavy cart. In those days transport was by horse and cart, and a horse doesn’t always do what it’s told — it came charging at someone, the cart rolled over him. He was crushed. It was a long time before he came to, and when he woke, his chest felt blocked, he could hardly draw breath. His cure was the same: a bowl of warm child’s urine, and his chest opened and the qi flowed — instant relief. Then a local gentleman, Mr. Xu Donghao, gave him a bowl of Fu Yuan Huo Xue Tang (Restore the Source and Invigorate Blood Decoction) — the formula that invigorates blood, dissolves stasis and nourishes the blood — and the stagnant blood was passed out, the swelling and pain retreated completely, and he was well.

Why does child’s urine work? It doesn’t disturb the organs — it never fails

Doctor Xue Lizhai said: whenever there is an injury, whether the person is strong or weak — and regardless of whether you can tell there is stagnant blood (at the moment of injury you simply cannot judge clearly) — quickly drink a bowl of warm child’s urine; adding a little wine is even better.

💬 Note from Doctor Luo: His reasoning: at the moment of trauma, other medicines can also invigorate blood and dissolve stasis, but you cannot tell whether stasis is present — and if you choose the medicine wrong, you only make things worse. Child’s urine does not disturb the organs and does not harm the qi and blood; it is extraordinarily mild. Whether or not there is stasis, if there is an injury you can drink it — it never fails. And it isn’t only for trauma: if there is distending pain in the chest and flanks, or fever with restlessness, dry mouth with a craving for cold — signs of liver fire, of heat — a single bowl of child’s urine alone beats other medicines. Doctor Xue Lizhai once asked soldiers in the army: when you drill and fight, you often fall from horses and get hurt — how do you treat yourselves when no physician is around? Every one of them said: child’s urine works best — drink a bowl of warm child’s urine and you heal fast. This was the repeated, proven experience of the ancients.

Child’s urine is salty and cold in nature. The ancients used it to nourish yin, descend fire, and invigorate blood and dissolve stasis — especially widely in the field of trauma. Traditionally it was taken from boys under twelve years of age, the younger the boy, the purer the urine.

Modern science: real medicines really are extracted from urine

Doctor Luo notes: nowadays, the moment science is mentioned, people find the idea of drinking urine ridiculous and unscientific — and so nobody studies it. In fact, child’s urine does have genuine effects.

💬 Note from Doctor Luo: Child’s urine is salty and cold; it clears heat and dissolves stasis remarkably well, and it is extraordinarily mild. Modern pharmaceutical research really does extract many medicines from urine — for example urokinase, an enzyme preparation that Western medicine uses; in some places they even collect urine from public toilets to extract drugs. And then there’s the most cutting-edge field in global medicine right now, fecal microbiota research: bacteria are harvested from the gut, made into capsules or given by enema, and introduced into the gut to treat disease — the ancients also made medicines from feces, and it turns out to be useful. You see, sooner or later foreign scientists will work it out: “there’s this and that in a child’s urine.” These experiences of the ancients will gradually all find their rational explanation.

What to take away

1. For an external injury, the order is fixed: clear the stasis first, then strengthen the upright. Reverse it and you make things worse — tonics pile up against the blockage, or you keep poking a wound with no strength behind it.
2. Thin, pale pus means deficient qi and blood; thick pus means the fight is being won. When a wound turns dark and won’t ulcerate, the upright qi is too weak to push the evil out — that’s when big doses of ginseng and astragalus are the right medicine, bloating or not.
3. Child’s urine as first aid for trauma — mild, harmless to the organs, effective whether or not stasis is present. An ancient remedy with a surprisingly modern biochemical footprint.

Bonus: the emperor died at 31 — health is not maintained by famous doctors

Doctor Xue Lizhai served as imperial physician and director of the Imperial Medical Institute — and his patient was none other than Zhu Houzhao. That emperor died at the age of 31. After Wang Yangming suppressed the Prince of Ning’s rebellion in the south, Zhu Houzhao insisted on personally leading troops on the trip. Near Zhenjiang he saw the fine water and thought fishing looked fun — he went down to haul the net himself, capsized the boat, fell in, and could not swim. Water flooded his lungs, and he caught a chill.

💬 Note from Doctor Luo: For an ordinary person, a mouthful of water and a chill means nothing. But this one? He had spent his days and nights in wine and lust — the Leopard House, beauties gathered from all over the empire — and his constitution was wrecked beyond repair. While Doctor Xue Lizhai was adjusting his health, the doctor himself fell ill from exhaustion — the emperor simply would not obey; there was practically no way to treat this disease. Back in Beijing, at a heaven-worship ceremony, the emperor suddenly vomited blood, and not long after, he died. What does this tell us? It tells us Doctor Xue Lizhai was a master — a famous physician who left behind more than three thousand case records, who treated the common people’s illnesses beautifully. But against an emperor, he was helpless. Health is not maintained by famous doctors. It is maintained by your own proper routine, your lifestyle habits, and by keeping your emotions optimistic. If you get all of that wrong, even the most celebrated physician in the history of Chinese medicine standing at your bedside may not solve the problem. Why did Doctor Xue Lizhai later resign his post as imperial physician and return to the people to treat ordinary patients? Because he knew deep down: the diseases of the imperial house simply cannot be treated — that is not something any physician can control. In the end, health is up to yourself.

Case source: Case Records of Doctor Xue (《薛氏医案》) by Xue Ji (Ming dynasty); commentary based on public lectures by Doctor Luo Dalun (PhD in TCM diagnostics, Beijing University of Chinese Medicine).