Sore, Swollen Throat and Ear Pain After a Cold? Doctor Wu Jutong’s Case of Damp-Heat Throat Block (Clear the Dampness First, and the Heat Lets Go)
What the patient was searching for: sore throat / throat pain / swollen throat / sore throat after a cold / throat feels blocked / ears hurt too Medical terms: hou bi (throat block) · acute sore, swollen throat · externally contracted epidemic toxin · damp-heat lodged in the throat
Opening: a swollen throat is no small matter
Today we continue with the medical cases of the great Qing-dynasty physician Doctor Wu Jutong (吴鞠通) (1758–1836). His given name was Tang, his courtesy name Jutong, and he came from Huai’an, Jiangsu Province. He is one of the founding figures of Warm Disease medicine (wen bing xue) — his book Wen Bing Tiao Bian (Systematized Identification of Warm Diseases) made his name known across the whole empire.
The illness in today’s case is called hou bi — throat block. What is hou bi? It is simply sore, swollen throat after a cold or external contraction — in ancient times, any disease with the word “throat” in it was grouped under this heading. Why does it deserve its own case? Because when the throat swells, sometimes it blocks — and when the blockage gets severe, it can genuinely become a matter of life and death. Please never underestimate it.
💬 Note from Doctor Luo: This case is recorded as happening on the 26th day of the sixth lunar month in the yi chou year (1805). What was the patient’s name? The transcript tells us only that his name contained the character “ling” (零). The most fascinating thing about this case is this — for the first two days, clearing heat and toxin did absolutely nothing; then the doctor added herbs to drain dampness, and the illness turned around at once. Hidden in here is a great principle of Chinese medicine for treating damp-heat. Let me tell it to you slowly.
The secret on the tongue: white at the edges, turbid in the middle — dampness hiding inside
When the patient came in, Doctor Wu Jutong examined the tongue coating very carefully — in this case the tongue is recorded in unusual detail: the coating was white at the edges but turbid in the center — that is, thick and greasy right in the middle.
The other symptoms: the throat was swollen and the ears hurt — that tells you heat toxin was congesting and binding there; dizziness, body heat, a racing pulse — clearly an externally contracted illness.
💬 Note from Doctor Luo: A tongue coating that is white at the edges and turbid in the center is a hugely important signal — it means there is dampness inside! There is heat, yes — but the heat did not come alone; it came wrapped in dampness. When you look at a throat illness, don’t fixate only on the heat. The moment the tongue coating turns thick and greasy, think of dampness — this is the key foreshadowing of the entire treatment.
Doctor Wu Jutong judged that this was li qi — a violent, foul atmospheric pathogen — that is, an especially fierce epidemic evil qi from heaven and earth striking the body. And he instructed the patient: above all, do not eat any grain-type food right now — you must observe dietary restrictions.
💬 Note from Doctor Luo: Dietary restriction is something the ancients took very seriously — look at Doctor Zhang Zhongjing’s formulas: after the Gui Zhi Tang, he tells you exactly what not to eat while taking the medicine. So for the ancients, dietary restriction was standard practice, not an optional extra.
The first formula: jie geng eight qian leading the charge, light and clear, floating and venting
Doctor Wu Jutong said: we must urgently open the gateways (ji kai guan qiao) — the throat is a little blocked, so open that pass at once. What method? Light, clear, floating and venting (qing qing xuan tou) — use gentle, soaring herbs to carry the pathogen out. He judged this to be basically a heat pattern, and somewhat urgent — when an external contraction reaches the point of sore, swollen throat, it is quite nasty.
The first prescription: jie geng (Platycodon root) eight qian (about 24 g), ren zhong huang three qian, bo he (mint) three qian, jie sui (schizonepeta spike) three qian, xuan shen (figwort root) one liang, niu bang zi (burdock seed) eight qian, huang qin (baical skullcap root) three qian, huang lian (coptis) three qian, ma bo (puffball) three qian, ban lan gen (isatis root) three qian, jiang can (stiff silkworm) three qian, plus lian qiao (forsythia) and jin yin hua (honeysuckle), and half a fresh lotus leaf with the stem removed. All ground into powder and divided into eight packets; one packet every two hours (yi shi xu), taken with a decoction of lu gen (fresh reed root).
💬 Note from Doctor Luo: Let’s start with jie geng — it is used in a large dose here. Its nature moves upward; it opens the lung qi and benefits the throat, and it also resolves toxin. In Doctor Zhang Zhongjing’s day, throat illnesses were treated with jie geng — the famous Jie Geng Tang (Platycodon Decoction). Doctor Wu Jutong also loved jie geng for throat problems.
Now jie sui — it is the ear-of-wheat-shaped part at the top of the jing jie (schizonepeta) plant. Usually we use jing jie itself to scatter and release, but jie sui grows at the very tip, so its scattering power is even stronger — and it is warm in nature. Bo he is acrid and cool, releasing the exterior, light and clear, benefiting the throat; niu bang zi benefits the throat and resolves toxin. Xuan shen here reaches one liang — it clears the throat, benefits the larynx, nourishes yin and moistens dryness — it can lift the yin fluids of the kidney upward and guide them to the throat, because the kidney channel ends at the throat. Xuan shen paired with jie geng is the line of the old formula Jie Geng Xuan Shen Tang (Platycodon and Figwort Decoction).
💬 Note from Doctor Luo: A piece of background knowledge here — the “yuan shen” in the formula is actually xuan shen (figwort root). Why is it written “yuan”? Because in the Qing dynasty, to observe the taboo on the name of the Kangxi emperor, Xuan Ye, the character “xuan” (玄) could not be printed, so medical books wrote “yuan shen” instead. Don’t mistake it for the “round ginseng” (yuan shen) sold in today’s ginseng plantations — this yuan is not that yuan; it is xuan shen, the figwort root. Anyone who reads classical literature recognizes a name taboo at a glance.
Ren zhong huang: licorice stuffed into a bamboo tube, soaked in a cesspit all winter
Among the ingredients of this formula there is one truly “mysterious” herb — ren zhong huang.
💬 Note from Doctor Luo: Before I explain ren zhong huang, a word of warning — if you are eating right now, mute the sound and finish your meal first, haha. When you hear the name “ren zhong huang,” do you think it is made of feces? Is Chinese medicine really about eating excrement? Hold on — let me finish.
What exactly is ren zhong huang? It is licorice (gan cao)! Here is how it is made: grind the licorice into powder; take a section of bamboo tube, bore a hole in each end, pack the licorice powder in tight, and seal both holes with pine resin — airtight. Then tie it with a rope and put it into a cesspit. Note: not in summer — in winter. This is a Jiangnan-region practice, recorded in Zhu Danxi’s Dan Xi Xin Fa (Teachings of Zhu Danxi). It soaks for a whole winter; when Beginning of Spring (li chun) arrives, take it out, dry it in the sun, split the bamboo open — the layer of licorice powder inside is ren zhong huang.
💬 Note from Doctor Luo: So ren zhong huang is not feces used directly as medicine — it is separated by a layer of bamboo, sealed tight, yet the qi can penetrate through. Current research suggests it does contain hormones from human excrement and some gut flora — the bacteria can multiply and seep into the bamboo’s woody structure. The ancients were genuinely clever: to today’s critics of Chinese medicine, ren zhong huang is the most mockable thing about the tradition; yet one day people may discover that our ancestors used something like “microbiome therapy” this early — how to select, how to preserve, how to filter, how to ferment — there is so much here worth pondering. What did the ancients use it for? Resolving toxin and cooling the blood — in epidemic fevers, or acute throat emergencies where toxic blood rages, ren zhong huang really worked. The classical texts mainly record it for severe epidemic disease. People rarely use it now, because modern life has grown so clean; but it offers an inspiration — when a plague is severe, the entire spleen-stomach-intestinal system collapses, and that is precisely when outside microbial intervention is needed, because the body’s own flora has already broken down. The ancient Chinese found a very special way to select and preserve it — that is remarkable wisdom.
Changing the formula: two days of clearing heat and toxin, yet the tongue coating did not budge
The formula was written on the 26th day of the sixth lunar month; when the doctor returned on the 27th: the tongue coating had become even more turbid — the pathogen was transforming very slowly. Doctor Wu Jutong simply added to the previous formula: huang qin two more qian to bring it to five qian, huang lian two more qian to bring it to five qian — raising the power of heat-clearing another notch.
By the 28th: damp-heat and the foul epidemic qi were wrestling together (shi re li qi xiang bo) — two external pathogens mingled and came at once; the throat was badly blocked and painful. Looking at the tongue again: thick, heavy, gray and dull. Doctor Wu Jutong said: the dampness absolutely must be transformed and dispersed (bi de shi qi xuan hua) — we have to wait for the dampness to dissolve gradually before the heat can be released.
💬 Note from Doctor Luo: Why can’t the heat retreat while the dampness stays? Remember this principle: dampness is tangible (you xing), heat is intangible (wu xing) — an intangible pathogen must attach itself to a tangible one. Dampness is that “form”; the heat hides inside the dampness. Remove the dampness and the heat loses its perch — of course it disperses. So in treating damp-heat, Chinese medicine has an iron rule: drain the dampness first, and the heat goes easily. That is the soul of this whole case.
So the formula was adjusted slightly: jie geng eight qian, ren zhong huang two qian, huang qin and huang lian five qian each, ma bo five qian, niu bang zi five qian, jiang can three qian, lian qiao, jin yin hua — and two new herbs added at the end: tong cao (rice-paper plant stem) three qian! xing ren (apricot kernel) five qian! plus jing jie two qian, bo he three qian, hua shi (talcum) one liang — and, fiercer still, xi jiao (rhinoceros horn) three qian. Ground into powder divided into ten packets, one packet every two hours, the powder boiled with fresh lotus-leaf edges and lu gen in water, strained, and drunk a little at a time.
💬 Note from Doctor Luo: The big difference between this formula and the earlier ones is the addition of herbs that drain dampness and promote urination. Tong cao — a white, lamp-wick-like stem — it guides dampness out through the urine; the more you urinate, the more the damp pathogen leaves, and the heat follows it out. Xing ren opens the lung qi — the lung governs the qi of the whole body; once the lung qi opens, all the water-dampness of the body comes alive. What is this called? Ti hu jie gai — “lift the pot, take off the lid”: open the lid of the teapot and the water below pours straight out. Hua shi is used at one liang — a large dose — and it too drains damp-heat pathogen out through the urine. As for xi jiao three qian — that is extremely fierce — it is forbidden today (rhinoceroses are protected animals); nowadays antelope horn (ling yang jiao) or water buffalo horn (shui niu jiao) is used instead. In the Qing dynasty, what did three qian of rhinoceros horn cost? My goodness — ordinary families could never afford it — this was a disease that only wealthy households could afford to treat.
The 29th: throat pain stopped, the battle won
One more day passed — the 29th: the throat pain stopped! The tongue coating was still thick and greasy, and the pulse was still a little fast — but the battle was won (da shi yi ding); there was just a little dampness inside not yet fully cleared.
💬 Note from Doctor Luo: Look — on the very first day of adding the dampness-draining herbs, the throat stopped hurting — this is where the turnaround happened! Not in the first two days of aggressive heat-clearing, but in the moment the dampness-draining and the heat-clearing worked together. Remember the timeline: the 26th, first visit; the 27th, more heat-clearing; the 28th, dampness-draining added; the 29th, throat pain gone — the moment the dampness transformed, the heat instantly had nowhere to stay.
At this point Doctor Wu Jutong cited the Ling Shu Jing (Spiritual Pivot): “In the warm diseases of the five viscera, the tongue coating belongs especially to the lung” (wu zang wen bing, yi she tai zhuan shu zhi fei) — warm diseases all relate to the lung channel, so the prescription must still mainly free and vent the lung qi. The reasoning: when the qi transforms, the dampness transforms too, and the fire has nothing to lean on (qi hua ze shi hua, er huo yi wu yi) — once the qi mechanism opens up, the dampness scatters; once the dampness scatters, the fire loses its place to cling. So he wrote the recovery formula: jie geng three qian, ren zhong huang eight fen (just a pinch), lian qiao two qian, jin yin hua two qian, huang lian one qian five fen, ma bo eight fen, tong cao one qian, xing ren paste one qian, hua shi three qian, one stalk of lu gen, half a fresh lotus leaf with stem removed. His instructions: take it for one day tonight, and one more day before noon tomorrow — and that would be that.
💬 Note from Doctor Luo: Look at the last few herbs — huang qin, lian qiao, jin yin hua — what are those three together? They are today’s Shuang Huang Lian oral liquid! Shuang Huang Lian is exactly these three herbs. So don’t imagine Shuang Huang Lian is a modern invention — this idea already existed in the Qing dynasty. In the recovery formula, the heat-clearers are huang lian, huang qin, lian qiao, jin yin hua and ma bo; the dampness-drainers are hua shi, tong cao and he ye; and xing ren opens the lung qi, which also helps drain dampness — this is the classic structure for clearing heat and draining dampness. If you want to learn how to clear heat and drain dampness, study this recovery formula and you will understand it.
Why did the first two days of heat-clearing produce no movement?
In this case the whole treatment process changed the formula every single day — the 26th, 27th, 28th and 29th, one look per day.
💬 Note from Doctor Luo: In the old days, some physicians stayed right in the patient’s home, examining the patient every day and changing the formula every day — sometimes the formula differed at different hours of the same day. That is what an acute illness deserves. So Chinese medicine can be quite luxurious: nowadays? A visit once a week, once a month — a formula to take home for a month — that is the business of slow, gradual regulation. When you meet a real acute condition, you need to be seen constantly. This case of Doctor Wu Jutong is the perfect example — examined daily, adjusted daily.
So why did the first two days of clearing heat and toxin seem to do nothing? Doctor Wu Jutong himself was wondering: why won’t the tongue coating transform? — Dampness! Only when he added xing ren, hua shi, tong cao — herbs that push dampness out and drain damp-heat through the urine — working together with the earlier heat-clearing and toxin-resolving herbs, did it work at once — the sore, swollen throat stopped immediately.
Doctor Luo’s summary: the turnaround was not in detoxifying, but in draining dampness
What do we learn from this case? Doctor Luo Dalun walked everyone through it again —
💬 Note from Doctor Luo: Back then Doctor Li Dongyuan had a famous formula, Pu Ji Xiao Du Yin (Universal Salvation Toxin-Dispelling Drink), with extremely strong toxin-resolving power; ordinary sore, swollen throats with congested heat toxin would improve as soon as it was used. But is every case of this illness identical? Would you say so? — No. In this case there was dampness — the tongue coating was especially thick and greasy — so you must think about how to drain dampness and phlegm-dampness: take the damp-heat away first, then clear the heat — the effect is better. So what Doctor Wu Jutong showed us is responding to circumstances (sui ji ying bian): for the same sore, swollen throat, Li Dongyuan’s Pu Ji Xiao Du Yin is the “correct answer” — but when you meet one wrapped in dampness, you must drain the dampness first.
💬 Note from Doctor Luo: This is where the Warm Disease physicians shine — they were especially good at treating damp-heat. Jiangnan has abundant dampness and heat, and many days of heavy-damp weather, so the warm-disease school studied in depth how, when dampness and heat are tangled together, to drain the dampness first and then clear the heat. Later, when I tell you Doctor Wu Jutong’s cases of externally contracted warm disease, you will see that he distinguishes dampness and heat with extraordinary clarity: remove the dampness first, and the heat is easy to clear. The core of this case: the turnaround came not from detoxifying alone, but from draining dampness plus detoxifying. Once you understand this, you know how Chinese medicine treats damp-heat.
Bonus: a little every day, and Chinese medicine starts to make sense
At this point Doctor Luo Dalun, as usual, has a few words of advice:
💬 Note from Doctor Luo: I talk through a small segment like this every day, hoping that as you listen, you come to understand more about the ideas of Chinese medicine. This is an invisible classroom — all of us gathered together every day, learning more about how the ancient physicians treated disease. It is all free, and I hope more people will come and listen — tomorrow, we continue with the stories of Doctor Wu Jutong’s practice.
The original case is from Wu Jutong’s Case Records (《吴鞠通医案》, hou bi / throat block section); the commentary is adapted from the public lectures of Doctor Luo Dalun (Ph.D. in TCM diagnostics, Beijing University of Chinese Medicine).