A Hard Lump Right of the Belly Button and a Swollen Testicle? Doctor Wu Jutong’s Case of Cold Hernia and Accumulation (Tiantai Wuyao San)
What the patient was searching for: lump right of the belly button / hernia / swollen testicle / swollen scrotum / belly pain from catching cold and getting angry / pain too severe to stand, sit, or lie down Medical terms: cold hernia (han shan) · accumulation (ji ju) · cold congealing in the liver channel · qi stagnation from cold
Opening: a vigorous 31-year-old man in so much pain he couldn’t stand, sit, or lie down
Today we continue with the case stories of the famous Qing-dynasty physician Doctor Wu Jutong (吴鞠通). The patient was 31 years old, a man in the prime of life — but the disease he had would make anyone wince just hearing about it: right of his belly button a lump had grown, about five cun across, a big hard mass. Worse still, one testicle had swollen up to the size of a goose egg, bulging out.
💬 Note from Doctor Luo: A lump five cun wide right of the navel, plus a swollen testicle — for this combination the ancients had a specific name: hernia (shan qi), or accumulation (ji ju). Hold that picture in your mind: a big hard lump bulging beside the belly button, and the genitals swollen below. This disease looks nasty — and it was.
How sick was he? Pain that allowed no standing, no sitting, no lying down
The lump didn’t just sit there quietly — it hurt. Doctor Wu Jutong recorded it precisely: unbearable pain; he could not stand, could not sit, and could not lie down — standing hurt, sitting hurt, lying down hurt. If no position gave any relief, just how much pain was that?
💬 Note from Doctor Luo: When the ancients wrote about illness, they chose their words carefully. That sentence — “could not stand, could not sit, and could not lie down” — is not padding. It tells you the pain was constant and severe, beyond what any posture could ease. That patient was truly suffering.
Where did the disease come from? Two culprits: cold + rage
How did the disease start? Doctor Wu Jutong analyzed it and found two causes.
The first was cold. Repeated chills, catching cold again and again — that drains the body’s yang qi. Once yang qi is insufficient, water-dampness can no longer be transformed and moved; qi and water stall in place and slowly knot into a lump.
The second was rage. He hit this one right on the head — diseases like this very often come from anger.
💬 Note from Doctor Luo: Cold and anger — one cold, one depressed — and both land squarely on the liver channel (gan jing). When the liver channel gets chilled and blocked, the places it passes through start to malfunction — lumps, hernias, all of it. Keep these two causes in mind; everything later in this case follows exactly this line of thinking.
Why does anger strike the belly and the genitals? The road map of the liver channel
You may ask: anger is an emotion — how does it end up in the belly and the reproductive organs?
The answer is in the course of the liver channel. How does it travel? It runs from both sides of the abdomen into the lower abdomen, links with the genitals, circles the reproductive system, and then continues down the legs.
💬 Note from Doctor Luo: So you see, the territory the liver channel passes through — both sides of the abdomen, the lower abdomen, the reproductive system — is unusually sensitive to emotion. Men are not exempt: some men, when their mood sours and stress piles up, develop male disorders such as impotence. And with that kind of impotence, tonifying the kidneys alone won’t help — take the pressure off, soothe the liver and free the qi, and it often gets better on its own. Women show it even more clearly: gynecological problems — menstruation, leukorrhea, pregnancy, childbirth — are often tightly bound up with emotion. A girl goes through heartbreak, grieves and fumes, and her period stops — amenorrhea — and needs slow, gentle treatment. Women are more easily affected by negative emotions precisely because the liver channel runs this way. That is the single most valuable lesson of this case.
First battle: the Muxiang Liuqi Drink — five days, not a ripple
With the disease understood, Doctor Wu Jutong first prescribed a formula — the book writes “Xinxiang Liuqi” (Pungent-Fragrant Qi-Moving), which he believed was a woodblock misprint; it should be the Muxiang Liuqi Yin (Costusroot Qi-Moving Drink).
That formula simply moves qi. The patient took it for five days, with some ingredients in quite heavy doses — and the result? Absolutely nothing. No effect whatsoever.
💬 Note from Doctor Luo: The Muxiang Liuqi Drink is a huge formula — ban xia (pinellia), zi su ye (perilla leaf), chen pi (tangerine peel), ding xiang (clove), rou gui (cinnamon bark), hou po (magnolia bark), huo xiang (patchouli), bing lang (areca seed), mu xiang (costus root), cao guo ren (tsaoko seed), tian dong (asparagus root), fu ling (poria), mu gua (papaya), bai zhu (atractylodes), ren shen (ginseng)… it both tonifies and moves qi — an extremely broad-spectrum formula. But sometimes that’s the problem: it seems to move every kind of qi, and therefore moves no kind of qi in particular. For ordinary spleen-dampness with qi stagnation and a distended, full belly, it works. But this patient’s knot was in the liver channel, with cold on top of it — and the Muxiang Liuqi Drink was “a square peg in a round hole,” its strength never landing where it was needed.
The switch: Tiantai Wuyao San — the formula made for hernias and accumulations from cold
Doctor Wu Jutong realized he needed a different formula. Which one? Tiantai Wuyao San (Tiantai Lindera Powder).
💬 Note from Doctor Luo: Tiantai Wuyao San is the formula specifically made for hernias and various accumulations caused by cold — it warms and moves qi at the same time. Its hallmark is razor-sharp targeting. Unlike the “broad-spectrum” Muxiang Liuqi Drink, it aims straight at the liver channel. The most fascinating part of this case is exactly this contrast: the broad formula failed, the targeted formula hit the bull’s-eye on the first try.
Breaking down the formula: herb by herb, every one working on the liver channel
Let’s look at the main ingredients of Tiantai Wuyao San one by one:
Wu yao (lindera root) — Tiantai lindera. Warm in nature, it moves qi and stops pain, and is especially good for qi-stagnation pain caused by cold. Besides entering the bladder channel and kidney channel, it also enters the liver channel directly — it disperses cold and stops pain for liver-qi stagnation arising from cold. It is the sovereign herb of the formula.
💬 Note from Doctor Luo: Where is the best wu yao grown? Mount Tiantai in Zhejiang — Tiantai County, Tiantai Mountain. Tiantai lindera is famous, one of the “Eight Great Zhejiang Herbs” (Zhe Ba Wei). By the way, Mount Tiantai is a wonderful place — Teacher Fan Changwei, who teaches our moxibustion, has a practice there and runs a charity as well. Notice something rare: the formula is named directly after its place of origin — “Tiantai Wuyao San.” That almost never happens in the formulary! Huai yam (huai shan yao) is famous too, yet nobody calls a soup “Wenxian Huai Shan Tang.” A formula bold enough to carry its hometown in its name is truly famous, truly authentic.
Qing pi (green tangerine peel) — moves qi, breaks qi, and soothes the liver. Xiao hui xiang (fennel seed) — warms the liver and disperses cold; it too enters the liver channel. Gao liang jiang (galangal) — disperses cold and stops pain. Mu xiang (costus root) — moves qi and stops pain, opening up the flow of qi.
Together these herbs are all warm, all aromatic, all capable of opening the qi — this is warming the liver and freeing the liver.
Chuan lian zi (toosendan fruit) prepared with ba dou (croton seed) — the preparation here is fascinating: chuan lian zi is a cool, draining herb for the liver, draining liver fire; ba dou is hot. The method: fry the ba dou together with the chuan lian zi so the croton’s power enters the toosendan fruit, then discard the ba dou and keep the chuan lian zi. This way the formula drains liver fire on one side while borrowing the croton’s driving force to push things outward on the other.
Bing lang (areca seed) — clears turbid, filthy qi, regulates intestinal qi, and helps push things out.
💬 Note from Doctor Luo: The ancients were remarkable — it is as if they already knew that these accumulations are often connected to the intestines, which is why they put gut-regulating herbs in the formula. See the whole strategy: the liver catches cold, cold congeals and qi stagnates, and trouble appears in the places the liver channel passes — the intestine bulges out, breaks, blows a big bubble, and that’s a hernia. So the ancient treatment was: warm the liver, soothe the liver, move the qi, and push it downward. This case shows that logic crystal clear.
Gatekeeper: the tongue — only use this formula when the tongue is pale with a white coating
Before prescribing, Doctor Wu Jutong examined the tongue. The patient’s tongue was pale in color, covered with a lot of saliva, and the coating was white — the classic picture of cold congealing and stagnation.
💬 Note from Doctor Luo: Pay attention to this checkpoint: if the tongue is bright red, with a yellow coating, that’s liver fire, that’s heat — and you must NOT use this formula. The same liver-channel problem can run in completely opposite directions, cold or heat — this gatekeeping is the real craft of Chinese diagnosis. Never get it backwards.
The medicine’s reaction was hair-raising: belly burning like fire, pain multiplied tenfold
The formula was written, and the patient began taking it. The reaction was hair-raising —
His whole belly burned like fire, as if a fire had been lit inside; at the spot right of the navel it felt like something was fighting within — “dissolving, dissolving.” And what happened then? The pain multiplied tenfold! Ten times worse than before. A modern patient might leap up and shout: “You gave me the wrong medicine?!”
💬 Note from Doctor Luo: Everyone — don’t panic. This is precisely the medicine working! The congealed cold is dissolving, the qi mechanism is churning violently, so it hurts more first. This “ten times worse” is not a bad sign; it’s the most intense moment of the struggle between healthy qi and pathogen. Get past this pass, and the road descends from here.
Countless buds rising in the belly — twenty or thirty rounds of gas, each lighter than the last
After the pain came the payoff: countless buds rose in the lower abdomen — it was as if a flower had opened inside his belly, little flower-bud-like swellings popping up, gurgle, gurgle.
And then? Each bud sinking down meant one release of gas; one round of gas, then another… twenty or thirty releases in all, every one of them downward-moving qi. When it was done, the pain in his belly loosened — no more pain.
But after a while, the pain came back; he took the medicine again, and again the belly heated up, again buds rose, again gas passed — only this time, a little lighter than before. So he kept taking it: starting from the chen hour (7–9 in the morning) all the way to midnight, five doses in total, each one a little easier.
By the next morning: only a slight ache remained in the belly. He took the Tiantai Wuyao San again, and his belly no longer felt hot — nothing like the burning before. After that he took it two or three times a day, and within seven days the swelling and pain were completely gone — the lump had vanished entirely.
💬 Note from Doctor Luo: The whole treatment looks dramatic — belly gurgling, endless gas, twenty or thirty releases. What is that? That’s the body clearing the passage! Ordinary people won’t react that violently, but passing gas after taking the medicine is entirely possible — the qi mechanism opens, the congealed cold dissolves, and the body recovers. The ancients said a medicine must have “real work in it” — this medicine truly penetrated the liver channel and did its job. Medicine must be targeted — that is the biggest lesson of this case.
Aftercare: he took up archery and martial arts and grew stronger and stronger
Once cured, the case record includes a follow-up: this patient later practiced archery, practiced kung fu, studied martial arts — and his body grew stronger and stronger.
💬 Note from Doctor Luo: What consolidates a cure? Exercise. The ancients said “practicing archery helps yang.” Training the body builds up yang qi, and then cold evil can never slip in again — which neatly echoes the “disease from cold” at the beginning of the case.
Doctor Luo Dalun’s summary: blocked liver qi travels one of two roads
What can we learn from this case? Doctor Luo Dalun walks us through a review —
First, medicine must be targeted. The Muxiang Liuqi Drink also moves qi — why didn’t it work? Because it wasn’t aimed specifically at the liver channel. Why did Tiantai Wuyao San work? Because it’s a formula made for this disease, entering the liver channel directly.
Second, cold and heat must be clearly distinguished. This case was cold — cold congealed the liver channel, on top of anger, frustration, and repeated chilling, so liver-qi stagnation produced the accumulation. But blocked liver qi actually travels two roads:
💬 Note from Doctor Luo: One road is turning into fire and heat — blocked liver qi smolders into fire, which injures yin, producing yin-deficiency heat or damp-heat. Many people take this road, and their tongues are red. The other road is catching cold — developing in the cold direction, cold congeals and stagnates, the tongue is pale, clean on both sides, and lumps grow in the belly. When the lump sits in a place the liver channel passes, you must absolutely not drain fire — draining fire is useless! You must warm the channel, move the qi, and disperse the mass. Tiantai Wuyao San is precisely the formula that warms the channel, moves qi, and disperses masses. And good news: this formula is available as a ready-made patent medicine — traditional formulas have been made into modern patent medicines; search “Tiantai Wuyao San” online and you’ll find it. It’s a required classic formula in every TCM college formulary course, effective for cold congealing, qi-and-blood stagnation forming lumps, and painful qi-and-blood stasis. So add one more piece of knowledge: blocked liver qi can turn into fire OR into cold — the direction is opposite, and the treatments are worlds apart.
Compiled from Doctor Luo Dalun’s commentary on Doctor Wu Jutong’s case records; the case comes from Wu Jutong’s Case Records (《吴鞠通医案》, Qing dynasty).