Drinking Water Feels Like a Knife Cut in Your Stomach, and You Haven’t Eaten in Ten Days? Doctor Wu Jutong’s Case of a Gastric Bezoar
What the patient was searching for: stomach pain / belly ache / even drinking water hurts / can’t get food down / haven’t eaten in ten days / a stone growing in the stomach Medical terms: gastric bezoar (wei shi zheng) · wei jia shi (stomach excess) · jie zheng (accumulation syndrome)
Opening: the man who had not swallowed a single grain of rice in ten days
Today we continue with the medical cases of Doctor Wu Jutong (吴鞠通) (1758–1836), one of the great Qing-dynasty physicians. His given name was Tang, his courtesy name Jutong, and he came from Huai’an, Jiangsu Province. He is counted among the Four Great Masters of Warm Diseases (wen bing si da jia), the author of the Wen Bing Tiao Bian (Systematized Identification of Warm Diseases), the founder of the San Jiao (Triple Burner) pattern differentiation system, and the creator of celebrated formulas such as Yin Qiao San (Lonicera and Forsythia Powder) and Sang Ju Yin (Mulberry Leaf and Chrysanthemum Drink). A towering figure of Qing medicine.
The patient in this case was a man surnamed Fu, 55 years old. What did 55 mean in ancient times? The old saying goes, “From seventy, human life has always been rare.” Fifty-five was already past the halfway mark — a fairly advanced age, which means his upright qi (zheng qi) would not be abundant. So Doctor Wu had to treat him with extra care.
The illness itself sounds terrifying: when he drank water, a single swallow cut through his stomach like a knife; and as for dry rice, he could not get a single mouthful down. For ten whole days, not one grain of rice had passed his lips.
💬 Note from Doctor Luo: In ancient times this illness was called jie zheng (accumulation syndrome) — also wei jia shi (stomach excess) — meaning that something solid and real was stuck inside the stomach. It is different from the illness called ye ge (dysphagia), the category that includes esophageal and stomach cancers: in ye ge, the passage itself is blocked; in jie zheng, there is a physical object lodged in the stomach. So the correct method was the xia fa (purging method) — to push it out from below. Notice that the ancient physicians had no gastroscope; they relied entirely on looking, listening, asking and pulse-taking — and still they recognized this disease.
Where the illness came from: a fine meal at a wine house
The whole affair began with a meal. Mr. Fu was a man who loved good food, and on this day he was drinking at a wine house, and with his wine he ordered a famous dish — shao xiao zhu xiang pi (roast suckling pig with crispy “crackling” skin).
💬 Note from Doctor Luo: What is shao xiao zhu xiang pi? It is roast suckling pig — roasted until the skin is brittle and crackles “ge beng ge beng” with every bite, which is why it is called xiang pi (“crackling skin”). This dish was famous. Empress Dowager Cixi adored it — the deep-fried pig skin snapping and crunching, fragrant and crisp.
He was enjoying his meal when a messenger arrived with bad news: something had happened to a friend! A grim report — perhaps a fight, a beating, or a friend fallen ill and lying in bed.
How could he sit still? In a panic, he dropped his chopsticks, hurried downstairs, and looked for his carriage. The man had money; he went about with a carriage driver at his service — like a modern boss with a full-time chauffeur. But when he got downstairs: the driver had gone off to eat, and there was no one to be found. With his friend waiting urgently, there was nothing for it — he set off on foot.
💬 Note from Doctor Luo: Mark this — it is the first cause of the illness: he was gripped by anxiety in the middle of a meal! The moment he panicked, his liver qi knotted up (gan qi yu jie). The spleen and stomach had just begun their work of transporting and digesting the food when this sudden anxiety “jammed” them — the transport stalled, and trouble followed.
So he walked on. He covered four or five li to the East Gate where his friend was supposed to be — no one there; he heard the friend was somewhere else, so off he trudged another four or five li — back and forth, eight or nine li on foot. The day was hot; he grew thirsty and exhausted, and along the roadside he saw a stall selling iced sour plum soup (bing zhen wu mei tang) — yes, iced sour plum soup already existed in the Qing dynasty — and he gulped down two big bowls. Only then did he hire a carriage home.
A year of doctors, each treatment worse than the last
Once home, something was wrong: a faint, nagging pain beneath the heart (the stomach region). At first he paid it no mind. But a month later the pain had grown worse, and worse still. He called in doctors and took their medicines — a whole year, with no effect. A full twelve months, every kind of physician, and nothing helped.
By May of the following year, how severe had it become? One swallow of water, and the stomach ached as if cut by a knife; dry rice could not be swallowed at all — for more than a month. By the eighth day of the intercalary fifth month, he could not take a single grain of rice — ten full days.
Only then was Doctor Wu Jutong called in.
Doctor Wu’s first look: this is not dysphagia — something solid is stuck in the stomach
Doctor Wu looked at the man: thin as kindling wood — after ten days without food, who wouldn’t be? His face was dark red, the color of ochre (zhe shi) — ochre is the color of dark red brick, dull and deep; this is a sign of blood stasis. And stomach trouble shows up on the face — the stomach channel (Stomach Meridian) happens to run right across the face.
Then the pulse: deep, full and forceful (chen shi you li) — deep and full, telling him that a solid pathogenic factor was lodged inside. He examined the abdomen: at the site of the pain a lump stood up, about the size of a peach — and the moment he pressed it, the patient cried out in unbearable pain.
Doctor Wu now had his answer: this was jie zheng (wei jia shi) — a solid mass stuck in the stomach, and the correct move was to purge it downward.
💬 Note from Doctor Luo: Pay attention to those four characters — mai chen shi you li (deep, full, forceful pulse). Chen (deep) means the illness lies deep inside; shi and you li (full and forceful) mean there is a solid excess in there — this is not a deficiency pattern. These words are the iron-clad evidence for using the purging method. Had the pulse been weak and failing, you would not dare to purge at all.
Da Cheng Qi Tang with qian niu: Zhang Zhongjing’s formula to open the way down
How to purge? Doctor Wu prescribed Da Cheng Qi Tang (Major Order the Qi Decoction) with qian niu added.
💬 Note from Doctor Luo: Da Cheng Qi Tang is a famous formula from Zhang Zhongjing’s Shang Han Lun (Treatise on Cold Damage) — just four herbs: da huang (rhubarb), mang xiao (mirabilite), hou po (magnolia bark), and zhi shi (immature bitter orange) — the classic purging formula that orders the bowels to move. What is it normally used for? When an external pathogen has entered the interior and created yang ming fu shi (Yangming bowel excess): constipation with a dry, stuck mass, abdominal pain that worsens with pressure, a dry yellow tongue coating with prickles, a red tongue body, and a deep, full, forceful pulse — a hard, tightly bound accumulation inside. Mr. Fu matched every single criterion.
To the formula Doctor Wu added qian niu — the seeds of the morning glory vine (the trumpet flower). The black seeds are called hei chou, the yellowish-white ones bai chou, and together they are known as hei bai chou (“black and white ugly”). It is a purging herb, and it is especially good at moving water — for edema and the like, it helps drive water out. Combined with Da Cheng Qi Tang, the downward-driving force becomes even stronger.
The prescription was made up and boiled into three bowls. The family read it and jumped in fright: “Da huang… this medicine is far too violent! Purging downward — is that really all right?” They did not dare to take it.
Divination before swallowing: the pain travels down, step by step
This family was wonderfully superstitious. Afraid to take the medicine — what to do? Draw a fortune slip (qiu qian)! They consulted the oracle, and the slip said: “You may take it; take it and you will be cured.” Only then did Mr. Fu drink the first bowl.
After the first bowl: the pain was no longer in the stomach — it had moved down to the navel. After the second bowl: the pain had reached the small intestine. By the third bowl, the pain was concentrated at the anus — the very end of the intestinal tract! At that moment the pain was beyond bearing, his belly cramping terribly — yet nothing would come out.
💬 Note from Doctor Luo: See how clear the disease mechanism is — the medicinal force was shoving the obstruction downward, stage by stage: stomach → navel → small intestine → anus. That proves the diagnosis was right: the thing was in the gut and moving down. But at the anus it would not pass — why? Because the object was too hard and too large; it was stuck at the gate.
What to do? Doctor Wu had a way: make half the original dose, boil and drink one bowl, and add the mi jian dao fa (honey suppository method).
💬 Note from Doctor Luo: The honey suppository is also Zhang Zhongjing’s method — honey boiled until thick, then, while still cool enough to handle, twisted into a stick and inserted into the anus. Once inside, body heat melts the honey, which moistens the intestine and dissolves dryness — a local lubrication. This is “attacking from both inside and outside”: the medicine purges from within, the honey eases from without, and the object jammed at the door is “slid” out.
Half a dose plus the honey suppository: an egg-sized black mass comes out
And the result? It came out! — a black object the size of an egg, with what looked like fine fuzz on it, and it was hard as rock — you could smash it and it would not break, stab it and it would not yield.
This was the thing that had blocked his stomach for half a year, cost him a year of fruitless doctoring, and left him ten days without a single grain of rice.
Recovery thread by thread: from soft noodles back to dry rice in five days
The moment the mass came out, the man revived:
- The next day: he could eat soft noodles — noodles boiled until very soft — half a bowl;
- A day later: he could drink rice soup (zhou tang);
- The third day: he could take congee;
- By the fifth day: he was eating dry rice again!
A man who had not eaten in ten days was back to dry rice in five — the illness was cured.
Aftercare: Wu Zhi Yin (Five Juice Drink) for cooling and moistening
After the purging, how was he nursed back? Doctor Wu used Wu Zhi Yin (Five Juice Drink).
💬 Note from Doctor Luo: Wu Zhi Yin is a formula from Doctor Wu’s Wen Bing Tiao Bian — five juices: pear juice (cooling, moistening dryness), water chestnut juice (bi qi, the crunchy aquatic tuber, nourishing yin), fresh reed root juice (xian lu gen, cooling), mai dong (Ophiopogon) juice (steep the herb, then juice it, nourishing yin), and lotus root juice (if lotus root is unavailable, sugarcane juice works too). What are the five juices for? Cooling and moistening — this illness carried heat and dryness inside, so it had to be nursed with cool, moistening nourishment. For cases like this Doctor Wu also often had patients drink milk — milk too is cooling and moistening; after recovery, a slow course of milk builds the body back up.
So what exactly was it? A gastric bezoar!
By now you may be asking: that egg-sized black mass — what on earth was it?
💬 Note from Doctor Luo: Modern medicine calls this gastric bezoar (wei jie shi) — a stone-like mass that forms inside the stomach. How does it form? Acid meets protein and binds. For example, eat a lot of persimmons or hawthorn, which contain tannic acid, and then eat eggs or drink milk — protein — and the tannin and protein bind together, easily forming a plant-based bezoar (phytobezoar). The classic combination: persimmon followed by eggs — the tannin and protein bind, and a stone really can form. There is also the hair bezoar — some people with pica swallow their own hair, and the hair mats into a ball in the stomach.
And our Mr. Fu? Sour plum soup (acid) + roast suckling pig crackling (protein) — and iced, on top of it all, at a moment of panic. Every unfavorable condition stacked up at once: the mass lodged in his stomach, became a chronic bezoar, grew and grew, hurt more and more, and finally even water would not go down.
When I was in medical school, the imaging course taught a case like this: someone had a stomach X-ray, and the stomach appeared perfectly round, with a thin rim around the edge and a dense, even shadow filling the middle — the radiologist said it looked like a total solar eclipse! It turned out the stomach was stuffed with one enormous bezoar, the size of an infant’s head — the whole stomach stretched full.
So remember this: persimmons, hawthorn, black dates, and winter dates — anything rich in tannic acid — must not be eaten in huge quantities at one sitting, and certainly must not be paired with large amounts of protein (eggs, milk, seafood), with lots of water chugged right after. A pile of hawthorn on an empty stomach, or raw persimmons, is asking for trouble. Elderly people with weakened stomach function, and people who have had stomach surgery, are especially prone to this.
💬 Note from Doctor Luo: Modern medicine treats a bezoar by breaking it up with a gastroscope, then promoting gastric motility (faster emptying and peristalsis) so it passes gradually. Doctor Wu Jutong had no gastroscope — but one press of the abdomen told him a mass was bulging in the stomach, and he simply purged it out with the descending method. The ancient approach achieved the same end as modern medicine — and more directly. The old physicians, even without “seeing” inside, could identify this illness and cure it. The ancients were remarkable.
Bonus: how you eat matters
So what can we learn from this case?
💬 Note from Doctor Luo: Look at how this man got sick — he paid no attention while eating! These days, meals have largely become social occasions: at home you chat while you eat, and outside it’s almost all business talk. Many people say, “I eat out at dinner and then come home and still need two bowls of instant noodles at night” — all talk, no real eating; the food goes down distractedly.
I once visited the Daoist temple on Mount Mao (Maoshan), where Master Li An (Li An daozhang) received us — very young, handsome, and full of insight. During the meal everyone kept peppering him with questions, until finally he could take no more; he put down his chopsticks and said: “In our Daoist tradition, we do not speak during meals. You have asked so many questions — let me put down my chopsticks and answer you, and when I am finished, I will eat again, all right?” By Daoist custom, eating is eating: no talking. The rest of us have grown so used to doing a dozen things at meals, eating absent-mindedly, that we never notice the taste of the food or chew slowly — and that is exactly when problems arise.
💬 Note from Doctor Luo: Chinese medicine describes the effect of emotion on digestion as gan qi heng ni ke pi tu — “liver qi running sideways attacks spleen earth.” When you are anxious or angry during a meal, liver qi knots up, the spleen and stomach come under attack, and transport stalls. My own mother was prone to anger; if she got angry at a meal, she would start hiccuping on the spot, and for days afterward the mere mention of food would set off the hiccups — the reaction was unmistakable.
What does Western medicine say? The gastrointestinal tract contains hundreds of millions of neurons, exquisitely sensitive to emotion — the moment you are anxious or angry, they immediately begin to inhibit or tense up: some segments speed up, others slow down. Your emotions absolutely govern the entire digestive process. Take Mr. Fu: the panic “jammed” his stomach’s peristalsis; then the exertion (eight or nine li on foot) diverted the qi and blood that should have been feeding the spleen and stomach’s digestive work; and finally the iced sour plum soup — the stomach, which should be warm and running smoothly, was “frozen” by the cold going in, slowing it further. The conditions piled up, and a serious illness was born.
So how you eat matters: chew slowly, combine sensibly — some foods simply should not be eaten together, so don’t put them together; keep your mood cheerful, don’t rush; and don’t go for the extra-hard, extra-hot stuff, the “must-try novelty, must-indulge” attitude — you really don’t need it. And don’t overdo the persimmons, hawthorn, or black dates.
💬 Note from Doctor Luo: In this case, every single unfavorable factor happened to land on Mr. Fu, and it nearly cost him his life — saved only by Doctor Wu Jutong’s single purging formula, applied with the precision of a master. So remember: gastric bezoar (wei shi zheng) is a real disease — sometimes a stone-like mass genuinely forms in the stomach and causes terrible suffering. The ancients recognized this illness long ago, and had a way to cure it. Savor the old physicians’ experience a little — it is truly remarkable.
Source: Wu Jutong’s Case Records (《吴鞠通医案》). Commentary adapted from the public lectures of Doctor Luo Dalun (Ph.D. in Chinese medicine diagnostics, Beijing University of Chinese Medicine).