A Hard Lump in the Belly and Constant Anger? Doctor Wu Jutong’s Case of Abdominal Mass (Zheng Jia) from Stagnant Liver Qi

An autumn day in 1825: the “lump” in a twenty-year-old’s belly

On the thirtieth day of the eighth lunar month in the fifth year of the Daoguang reign (1825), a young woman of about twenty came to see Doctor Wu Jutong (吴鞠通). Her family name was Wang, and she was not yet married — in ancient times, still single at twenty already made her a “big girl.”

What was wrong with her? A hard lump had grown in her belly. Press it and it felt firm and unyielding. The old physicians called this zheng jia (癥瘕) — a mass that forms inside the abdomen. In today’s terms, it might have been any of a number of benign or malignant growths, or a knot of congealed blood.

💬 Note from Doctor Luo: Pay attention — the fact that she was unmarried had everything to do with this illness! Liver qi stagnates when the emotions are blocked. At home, day after day, she was in a storm: either she was ill-tempered because no one had married her, or no one dared marry her because she was ill-tempered — either way, she was angry every single day, and all that anger was trapped inside her body.

Doctor Wu Jutong reads the pulse: the left pulse, sunken and hidden, as if gone

This was no light illness. When Doctor Wu Jutong took her pulse, the left wrist (which reflects the heart, liver and kidney) was sunken and hidden, as if it were not there at all — so deep it could barely be felt! The right wrist was much the same. You can imagine how thoroughly her qi was knotted up.

His judgment: the blood sector of the lower burner was completely blocked (下焦血分闭塞). Qi and blood in the liver and kidney region were so severely congested that circulation in the lower body had stopped, and where it stops, lumps form. He wrote down eight characters: “此干血劳之先声也” — “This is the herald of gan xue lao (干血劳), dry blood consumption.” Left untreated, she would slowly drift into that disease.

💬 Note from Doctor Luo: Gan xue lao is a very serious gynecological condition: internal heat plus accumulated blood stasis stop the movement of qi and blood, the body slowly consumes itself, the periods stop, and the woman wastes away. By that stage the patient is already depleted to the extreme, with deficiency and excess tangled together — truly hard to manage. So Doctor Wu Jutong said: we must begin correcting this right now.

The surprise: the first prescription was for the mind

Most doctors, seeing a lump in the belly, would immediately open with a stasis-resolving formula. Not Doctor Wu Jutong. First he told the patient the cause of her illness, then he taught her how to adjust her mood:

“急宜调情志，切忌恼怒，时刻能以恕道待人，则病可愈。” — “Urgently regulate your emotions. Above all, do not rage. At every moment, treat others with forbearance and forgiveness. Then the illness can heal.”

In plain words: fix your temper, stop exploding, forgive people — that is how you get better.

💬 Note from Doctor Luo: This is the level Doctor Wu Jutong operated at! Some doctors simply prescribe: “Off you go, see you next week, here’s another month of medicine.” Doctor Wu Jutong was different — he told the patient the cause, and showed her how to cooperate by adjusting her emotions. Treat the body and the mind together: heal the body, and heal the heart too. Every genuinely great physician takes the emotions seriously. A zheng jia mass born of stagnant liver qi has its root in the emotions.

And why was this young woman sick in the first place? Think about it: twenty years old, unmarried, and known for her temper — who in the neighborhood didn’t know? What family would dare marry a “little empress” and enshrine her at home? No one came to propose, she couldn’t find a husband, and that made her angrier still — the more her qi stagnated, the sicker she became.

The prescription: resolve the liver and open its channels

The emotions needed work, but so did the medicine. Doctor Wu Jutong prescribed on the principle of hua gan li qi — resolving the liver and moving qi — and the formula was put together with great care:

• Xin jiang sha (新绛纱), three qian (about 9 g) — what is this? It is freshly woven silk gauze dyed with madder (qian cao, 茜草), the herb’s power still at full strength (in some regions the silk was dyed with aromatic spices). Madder activates blood and unblocks the collaterals, and the fine silk threads themselves help thread through and open the channels. This was one of Doctor Wu Jutong’s customary herbs for soothing the liver, moving qi and unblocking the liver channels.
• Tao ren ni (桃仁泥), three qian (about 9 g) — peach kernel pounded into a paste so more of its active principles come out in the decoction. Peach kernel resolves tangible blood stasis (while safflower resolves the intangible kind — which is why peach kernel and safflower are so often used together).
• Guang yu jin (广郁金), three qian (about 9 g) — moves qi, opens the chest, breaks up stasis, stops pain, and also cools the blood and calms the heart.
• Su zi shuang (苏子霜), three qian (about 9 g) — perilla seed that has been stir-fried and pressed free of oil, so it will not loosen the bowels; it has a descending, qi-lowering action.
• Xuan fu hua (旋覆花), three qian (about 9 g) — of all flowers, only inula flower descends (诸花皆升，唯旋覆花独降). While most blossoms send qi upward, this one carries it down — ideal for moving and lowering qi.
• Dang gui xu (当归须) — the fine root fibers of angelica; they unblock the collaterals, nourish the blood and move qi through them.
• Jiang xiang (降香) — dalbergia wood, to move qi.
• Gong ding xiang (公丁香) — clove buds, to warm the middle — because there was cold inside, and it needed warming.

💬 Note from Doctor Luo: Nowadays when people buy angelica they just grab a handful of “whole angelica.” Old physicians were far more particular — the head, the tail, the body and the fine root fibers of angelica each had its own job, each went to its own place. That refinement has faded; it has become vulgarized. As for clove: cloves come in male and female forms — the dried flower buds are gong ding xiang (male clove), the ripe fruit is mu ding xiang (female clove). Both are warming, and for most formulas the male clove alone suffices. Notice that in this formula clove was paired with yu jin — and the old adage says “clove must never meet yu jin” (one of the classic Nineteen Incompatibilities), so the two are normally never used together. Doctor Wu Jutong used them together anyway, in small doses — and no harm came of it. When the ancient masters deliberately paired herbs that were said to oppose each other, that was the audacity of a great physician.

Four doses later: the pulse still would not rise

The formula looked excellent — yet after four days of taking it, the girl’s six pulses were still sunken and hidden, not a flicker of movement.

Doctor Wu Jutong reflected: “The illness is heavy, and the medicine is light” (病重则药轻). It seemed there was cold lodged in her body as well, and herbs that only moved qi and blood could not supply enough force. So he added chuan jiao tan (Sichuan pepper charcoal), three qian (about 9 g), and gao liang jiang (galangal), two qian (about 6 g) — warming herbs to reinforce the first formula.

At the same time, he brought out another of his celebrated formulas — Hua Zheng Hui Sheng Dan (化癥回生丹), the Transform Masses and Return Life Pill.

A famous formula enters the scene: Hua Zheng Hui Sheng Dan

Hua Zheng Hui Sheng Dan is made into pills, taken one pill in the morning and one in the evening. Doctor Wu Jutong instructed: it might take three or four hundred pills — but on no account change course (断不可改弦易辙). You must persist, swallowing it one pill at a time, until the mass is eaten away.

How grand is this formula? It opens with bie jia (turtle shell), one jin (about 500 g) — clears deficiency heat and conducts the pathogen out; ren shen (ginseng), six liang (about 180 g) — builds up the upright qi (zheng qi); tao ren (peach kernel), three liang (about 90 g) — resolves stasis, taking care of both yin and yang aspects; yi mu cao paste (motherwort), eight liang (about 240 g) — the great gynecological herb for regulating qi and blood; shu di huang (prepared rehmannia), four liang (about 120 g) — supplements kidney essence…

💬 Note from Doctor Luo: I have talked about this formula before; let me go through it again. Safflower with peach kernel — safflower two liang. Gong ding xiang (clove), three liang — warming. Bai shao (white peony), four liang — to restrain and protect the yin. She xiang (musk), two liang — this is the ingredient that carries the medicine’s power into every corner of the body and opens the orifices! But today genuine musk is almost impossible to obtain; only artificial musk exists. Even in the old days, laying hands on two liang of real musk was no small feat — and that is precisely where this formula becomes difficult.

And the rest of the list:

• Xiao hui xiang tan (fennel charcoal), three liang — warming
• Dang gui wei (angelica tail), four liang — unblocks the channels
• Gan qi (dried lacquer), two liang — the resin of the lacquer tree, hardened into lumps; activates blood and unblocks collaterals, especially used in gynecological menstrual pain
• Wu ling zhi (flying squirrel droppings), two liang — moves qi
• Xing ren (apricot kernel), three liang — opens the lung qi
• Chuan xiong (ligusticum), two liang — regulates qi and blood
• San leng (sparganium), two liang — breaks up stasis
• Su mu (sappan wood), three liang — moves qi and unblocks collaterals
• Xiang fu (cyperus), two liang — moves qi
• Su zi shuang (perilla seed frost), two liang — moves qi
• Guan gui (official cinnamon), two liang — high-grade cassia bark
• E wei (asafoetida), two liang — a resinous gum with a dreadful smell, but its ability to dissolve lumps and scatter masses is first-rate
• Yan hu suo (corydalis), two liang — moves qi, scatters masses, stops pain
• Jiang xiang (dalbergia wood) — moves qi
• Ai tan (moxa charcoal) — warming
• Pian jiang huang (turmeric slices), two liang — disperses wind, moves qi, stops pain
• Wu zhu yu (evodia) — warms the liver
• Gao liang jiang (galangal) — warming
• Liang tou jian (“two-tipped” anemone root), two liang — expels wind, unblocks collaterals, stops pain
• Ru xiang (frankincense) — moves qi, stops pain, resolves stasis
• Mo yao (myrrh) — paired with frankincense, breaks up blood stasis
• Meng chong (gadfly), two liang — an extremely powerful blood-breaking agent
• Pu huang tan (cattail pollen charcoal) — moves qi, stops pain
• Da huang (rhubarb), eight liang — prepared the classic way: steeped and boiled thick in one and a half jin of rice vinegar, dried, then treated with vinegar again, repeated three times; the vinegar tames the rhubarb’s harshness while sharpening its stasis-resolving power.

All the ingredients are ground into a fine powder, mixed with the turtle shell, rhubarb and motherwort paste, refined with honey into pills, each pill weighing one qian and five fen, and sealed in a wax coating. Take on an empty stomach with warm water; where stasis is very severe, send the pill down with yellow rice wine (huang jiu).

💬 Note from Doctor Luo: Frankincense and myrrh are both plant resins — imported from Africa, brought into China as early as the Tang dynasty. Don’t imagine that Chinese medicine was a fixed, unchanging tradition; plenty of foreign medicinals made their way into it. These two smell dreadful, but their ability to move qi, stop pain and resolve stasis is outstanding — Doctor Zhang Xichun praised them too when he discussed herbs.

What does this formula treat? The original text lists a long string of indications: masses that neither disperse nor ache; zheng jia masses that hurt severely; blood bi (血痹) — circulation so obstructed that blood literally stops; left flank pain with chills and fever — a mass under the ribs with the body suddenly running hot and cold; women’s gan xue lao of the excess type — amenorrhea, emaciation, and blood stasis inside; women’s pre-menstrual pain — that is, dysmenorrhea, so you can see the term “painful periods” already existed in ancient times; chills and fever as the period approaches; belly pain from eating raw-cold food during the period; amenorrhea from blood stasis; menstrual blood so dark purple it comes out clotted; postpartum stasis pain — lower abdominal pain that refuses pressure; back pain from falls and injuries; fainting from a heavy fall — knocked senseless as if dead; knife wounds and beating injuries with lingering stasis. In short: all kinds of blood stasis — especially gynecological stasis — come under its reach.

💬 Note from Doctor Luo: This medicine really ought to be manufactured today! A pharmaceutical factory could source the ingredients in bulk and prepare the honey pills properly — it would not be difficult. Women with blood stasis are extremely common, and this is a genuinely usable remedy. The only problem is that single ingredient, musk, which cannot be assembled, and the treatment is slow besides. So the best strategy is: don’t let stasis form in the first place. Stop being angry all the time.

Two months later: the pulse comes alive, the periods flow

On the seventeenth day of the tenth lunar month, the young woman came back for her second visit — about six weeks after that first consultation on the thirtieth of the eighth month.

In the meantime she had taken 22 doses of the channel-warming, network-opening medicine and more than forty pills of Hua Zheng Hui Sheng Dan. Doctor Wu Jutong looked at her and said: “业已见效不浅” — “the effect is already considerable”! The pulse that had once been impossible to feel was now animated (脉亦生动) — bouncing, full of strength; and her periods were flowing freely again (经亦畅行).

Doctor Wu Jutong’s instruction: “当减其制之药” — reduce the dosage. Take only one pill of Hua Zheng Hui Sheng Dan each morning on an empty stomach; since it is working, there is no need to increase it. And he emphasized strict dietary taboos: no raw or cold food, no pork, and no shellfish — crabs, clams, and the like.

💬 Note from Doctor Luo: Why no pork? Pork is yin in nature. Have you ever wondered why braised pork belly calls for so much Sichuan pepper and star anise? Precisely to restrain that yin quality. As for shellfish — crabs, clams, anything in a shell — they are almost all cold and cooling by nature. (The hairtail fish from the sea, by contrast, is warming.) So raw-cold foods, pork and shellfish must all be set aside; only then can you complete the recovery in full (收全功) and slowly return to complete health.

Finally, Doctor Wu Jutong wrote one more soothing-liver, qi-moving formula (疏肝理气方): xin jiang sha (madder-dyed silk gauze), guang yu jin (turmeric root tuber), xiang fu (cyperus), xuan fu hua (inula flower), dang gui xu (angelica root fibers), jiang xiang (dalbergia wood), guang chen pi (tangerine peel), and su zi shuang (perilla seed frost) — decocted into three cups and taken in three portions. “此方常服，可痊愈” — take this regularly, and you can be fully cured. Used together with Hua Zheng Hui Sheng Dan, taken steadily until well.

Where was the root of the disease? Emotion — a depressed liver, not a blazing one

The case record ends here. But the reflection it leaves us is more valuable than the formulas:

What kind of constitution did this young woman have? Everyone assumes that a bad temper means “liver fire blazing high.” That is not what Doctor Wu Jutong saw. Hers was what he called liver-wood depressed and sinking (肝木郁陷): the liver qi was knotted up inside — not liver fire flaring upward (her face was not red, her eyes not bloodshot), but suppressed anger, grinding against people, with insufficient yang qi and insufficient liver yang — a quiet, “yin” sort of state. That is why her formulas were so full of warming herbs — and Hua Zheng Hui Sheng Dan itself works on the principle of warming yang and resolving stasis. For someone truly in that condition, this medicine is extremely effective.

💬 Note from Doctor Luo: A great deal of the blood stasis seen in people today comes from cold — eating cold food, feeling emotionally smothered, “raging” every day while actually being suppressed… all of it slides the body into a “yin” state. For stasis accompanied by cold, Hua Zheng Hui Sheng Dan works beautifully. It is a pity that such a classic formula has never been fully developed. If one day these formulas of the ancient masters could all be brought back into production, they would genuinely benefit ordinary people.

And look at the present day: why do so many people find thyroid nodules, breast nodules, uterine fibroids, ovarian cysts, and all kinds of hyperplasia on their checkups? There are many causes, but one stands out — bad mood, heavy stress, anxiety and tension, so that the liver qi cannot unfold and spread. When qi and blood flow freely, a person is healthy; when qi knots up, things start to grow.

💬 Note from Doctor Luo: This kind of qi-and-blood stasis born from emotion is actually hard to treat — even a master like Doctor Wu Jutong needed a long course. And when it comes to the medicine itself, Hua Zheng Hui Sheng Dan is troublesome to make, and you cannot even assemble the musk. So do your best not to stagnate — stop being angry all the time! Stasis forms lumps, lumps form tumors; benign or malignant, either way they are hard to handle and demand enormous effort to correct. Where is the root? Bad mood → stagnant liver qi → blocked qi and blood — that is the disease root. Regulate your emotions, find some happiness every day, and remember the old saying: “没病一身轻” — no illness, a light and easy body. People without disease are the fortunate ones. That is the takeaway from this case.

Compiled from Doctor Luo Dalun’s explanation of the case records of Doctor Wu Jutong, originally from Wu Jutong’s Case Records (《吴鞠通医案》, Qing dynasty).