Seven Years of Raving Madness? Doctor Wu Jutong’s Case of Mania Cured by Draining Heart-Gallbladder Fire with Gentian
What the patient was searching for: going mad / mania / talking nonsense / mental derangement / schizophrenia / insane for years Medical terms: mania and madness (dian kuang) · manic disorder (kuang zheng) · heart and liver fire blazing (the manic state of schizophrenia)
Opening: a man chained to a stone millstone
On the second day of the tenth lunar month, a special patient came — or more precisely, was escorted — to the consulting room of the great Qing-dynasty physician Doctor Wu Jutong (吴鞠通). The man was 32 years old, and he had been mad for seven years. For all seven of those years, the stone millstone in front of his house had been his “prison”: his hands and feet were bound with iron chains and locked to the millstone, because the moment he was set loose he smashed things and tore down doors and windows, giving the whole family no peace at all.
💬 Note from Doctor Luo: The physician in today’s story is the great Qing-dynasty warm-disease specialist Doctor Wu Jutong — the author of the Systematic Differentiation of Warm Diseases (《温病条辨》), and the inventor of Angong Niuhuang Wan (Bezoar Resurrection Pill). In his day in the capital he was practically the “fire-brigade captain” — every hard-to-treat case was sent his way. This mania case today has plenty of ups and downs, and it is well worth hearing.
Who was the patient: a failed imperial examination, and one shock that lasted seven years
How did this man go mad? In two words: 功名不遂 — his pursuit of rank and fame did not succeed. He failed the imperial examinations, and the shock broke his spirit. In today’s language: he took a crushing blow from failing the big exam, never recovered from it, and slowly developed into a manic type of schizophrenia.
💬 Note from Doctor Luo: Many parents will understand this immediately — quite a few young people today develop mental problems after examination failure. The ancients put it elegantly, “功名不遂”; plainly put, the gap between life’s expectations and reality was too great, and that one breath of qi couldn’t turn the corner.
During those seven years the family spared no expense. They had seen every famous physician in Beijing; they also invited doctors from Huizhou, from Hangzhou, from Suzhou, from Hubei — no fewer than several hundred physicians in all. And what was the effect? Doctor Luo Dalun sums it up bluntly in his lecture — most tonified deficiency; few attacked excess. Everyone reasoned that a man this sick must surely be deficient, so they tonified for all they were worth. He would improve a little now and then, then flare up again two days later — not one peaceful day in all that time.
One look, and Doctor Wu Jutong saw it: lower body bright red, clothes torn off — this is EXCESS, not deficiency!
When Doctor Wu Jutong saw the patient, he was startled: disheveled hair, a filthy face, the lower body bright red, and clothes that simply could not be kept on — the moment a garment was put on him he tore it off, screaming naked at the top of his lungs. And look around: every door and window had been smashed; the room was complete chaos. The family added that he had one more strange habit: every single day he had to see a woman. If no woman appeared, he howled at the top of his lungs, hoarse and desperate, too painful to listen to. Only when his wife or concubines reluctantly came to attend him could he quiet down for a while — and the next day it started all over again. Not one day was empty.
💬 Note from Doctor Luo: Everyone, pay attention to these details — lower body bright red, clothes torn off: that is evidence of HEAT! Many people see years of madness and assume it must be deficiency, so they tonify — and the more they tonify, the worse it gets. Doctor Wu Jutong took the pulse: all six positions were stringlike, long, and forceful (弦长而劲), leaping “thump, thump, thump” with real strength. And he knew in his heart: this is an excess syndrome, not a deficiency syndrome.
The fire-draining method: to drain the heart you must drain the small intestine — the gallbladder has no outlet of its own and borrows the small intestine
Since it was an excess syndrome, the only way was extremely bitter medicine to drain the fire of the heart and gallbladder channels. And here is hidden the core of Doctor Wu Jutong’s method for treating mania — the single most crucial stroke of the entire case:
💬 Note from Doctor Luo: Doctor Wu Jutong said: to drain the heart, you must drain the small intestine. How does heart fire get out? It goes through the small intestine and leaves the body in the urine. And what about the gallbladder? The gallbladder has no direct outlet, so it too must borrow the small intestine as its exit — you drain the small intestine for both. That is why, in treating mania, draining the small intestine is the top priority. This one sentence is Doctor Wu Jutong’s master key for treating mental-spirit diseases. Everyone, remember it.
The first formula: gentian leading the charge — two doses and it already worked
The formula was written, and the very first herb was long dan cao (gentian root), three qian (about 9 g) at the head, draining liver-gallbladder fire. It was paired with tian dong (asparagus root), mai dong (ophiopogon root), and xi sheng di (raw rehmannia) to nourish yin — because this man’s yin was also deficient; he had both excess heat and deficiency heat. Hu huang lian (picrorhiza) drains liver-gallbladder fire (it is NOT the same thing as huang lian), huang lian (coptis root) drains heart fire, and dan pi (moutan bark) drains liver fire.
💬 Note from Doctor Luo: In treating this kind of disease, Doctor Wu Jutong loved long dan cao more than anything — bitter and cold, striking straight down, dousing the fire of an excess syndrome with a violent drenching. And sure enough: after two days — great effect. The patient calmed down a lot — fewer wild movements, less raving. The whole family saw it: there’s hope!
The setback: as soon as the bitter herbs were reduced, the disease crashed back — “he is surely going to die”
But on the third day, Doctor Wu Jutong made a “good intentions, bad outcome” mistake. He reasoned: this man has been sick for seven years, his constitution must be weak underneath — can he really tolerate such bitter-cold medicine? So he cut back the bitter herbs and added some sweet, moistening, yin-nourishing herbs. And that ruined everything — from the third day to the fifth, two doses later, the disease crashed back in force!
The family came running, white-faced: “Sir, the more your medicine is taken, the worse he gets. This disease can’t be cured — we reckon he is surely going to die (量其必死). Please, don’t come anymore.”
💬 Note from Doctor Luo: Most people would lose heart at this point. But what did Doctor Wu Jutong say? He said: “No — now I know the advances and the retreats.” What does that mean? When I used the heavy formula at the start, it clearly worked; when I switched to a light formula with yin-nourishing herbs, it seriously worsened. That one positive and one negative tells me exactly how heavy the fire is, and exactly how I should adjust my measure. This trial failed — but now I know precisely which way to go.
The target-shooting story: the first two shots miss because the sights need calibrating
Here Doctor Luo Dalun tells a wonderfully down-to-earth story to explain Doctor Wu Jutong’s thinking:
💬 Note from Doctor Luo: It’s like shooting balloons at a fairground air-rifle stall. Your first two shots always miss — not because the gun is bad, but because the stall owner has knocked the sights out of alignment. You fire the first shot and see where the pellet lands; you correct the second shot according to the miss; once the sights are calibrated, every shot pops a balloon and the stall owner starts to fear you. Doctor Wu Jutong’s first two prescriptions were exactly that — calibrating the sights: first probe how heavy the fire really is; once he knew, it was one balloon per shot. This is the method of treating disease — and it is also a method for life: trial, error, then correct.
The heavy bitter-cold formula: gentian 6 qian, coptis 5 qian, aloe 6 qian
Doctor Wu Jutong took the pulse again — still stringlike, long, and forceful; the fire was still there. So he piled on the bitter herbs: long dan cao (gentian) six qian (about 18 g), tian dong (asparagus root) five qian, zhen huang lian (genuine coptis) five qian, lu hui (aloe) six qian, plus hu huang lian to drain heat, dan pi to drain liver fire, mai dong to nourish yin (only two qian this time), and wu mei rou (smoked dark plum flesh) five qian — sour and astringent, to gather the liver qi back in. And one more unusual ingredient: qiu shi (autumn mineral) — crystals crystallized from boys’ urine and salt, which nourish yin and drive fire downward. The whole thing was decocted into three bowls, taken in three doses.
💬 Note from Doctor Luo: Look at this formula — long dan cao, huang lian, lu hui: all fierce bitter-cold herbs, and in unusually large doses. This is what the ancients called “bending the fire straight down” (直折其火). Using lu hui (aloe) to drain liver-gallbladder fire was another of Doctor Wu Jutong’s signature moves. The wu mei rou’s sour astringency is there so the draining doesn’t injure liver qi — the fineness of his craft shows exactly in touches like that.
And the result? He took it straight for six days, better every single day. By the eleventh day, the patient was “much clearer” (大为明白) — his mind had turned around; he was beginning to come back to himself.
Mind medicine: Doctor Wu Jutong’s counseling
At this point Doctor Wu Jutong brought out another of his specialties — counseling. He modeled himself on Zhu Danxi, believing that psychological guidance matters enormously. He called the patient over and started working his words: “How did you get this disease? You failed an examination, and you destroyed yourself over it? Think — a single lapse of thought (念头之差). Your insight was not yet deep enough to write essays at the highest level; and even when you did write well, you might still not pass — fate is at work; it is not something human strength can force (命在，非人力之所能强为).”
💬 Note from Doctor Luo: Doctor Wu Jutong even gave examples: some people wrote brilliant essays and still did not pass — why? It was their fate. Some people had names that displeased the emperor — he stripped the already-appointed zhuangyuan (top graduate) right off. So in examinations, fate is involved; it is not something human effort can force. Why rage against yourself? Besides — you have been sick for seven years; your parents’ hearts have been wrung dry for seven years. Scholars are taught filial piety — is this how you honor your parents? Every sentence struck home. The patient bowed his head, speechless (俯首无词).
Half a month later, the shackles came off — and Zhuan Xi Da Sheng Gao finished the job
From that day on, Doctor Wu Jutong gradually reduced the bitter herbs and increased the yin-nourishing ones. Half a month later, the shackles were removed — the leg irons and handcuffs came off, he could wear clothes again, and in the morning he knelt with the family to bow to his parents and ask after their health. His mind was no different from any normal person’s.
Finally, Doctor Wu Jutong prescribed a batch of Zhuan Xi Da Sheng Gao (the “Focused-Contraction Great Birth” Paste) — one of the famous formulas Doctor Wu Jutong invented himself (Angong Niuhuang Wan was also his creation).
💬 Note from Doctor Luo: Zhuan Xi Da Sheng Gao is the formula Doctor Wu Jutong established when he discussed autumn dryness: when dryness evil persists for a long time it injures the yin of the liver and kidneys — upper excess and lower deficiency, cool by day and feverish by night, sometimes dry cough, sometimes convulsions and twitching. In such cases this paste tonifies slowly, building the yin up bit by bit — this is the sour-sweet yin-gathering method (酸甘敛阴法); Ding Feng Zhu (Wind-Settling Pearl) and San Jia Fu Mai Tang (Three-Shell Pulse-Restoring Decoction) belong to the same school. This formula covers tonifying qi, nourishing yin, and filling essence all at once, and it is unusually rich in “blood-and-flesh, sentient” products (血肉有情之品).
The preparation is elaborate: ren shen (ginseng), fu ling (poria), gui ban (tortoise plastron), wu gu ji (black-boned chicken), bie jia (softshell turtle shell) one jin, mu li (oyster shell) one jin, bao yu (abalone) two jin, hai shen (sea cucumber) two jin, bai shao (white peony) two jin, wu wei zi (schisandra) half a jin, mai dong two jin, yang yao zi (lamb kidneys) eight pairs, zhu ji sui (pig spinal cord) one jin, ji zi huang (egg yolks) twenty, e jiao (donkey-hide gelatin) two jin, lian zi (lotus seeds) two jin, qian shi (foxnut) two jin, shu di huang (prepared rehmannia) three jin, sha yuan ji li (flatstem milkvetch seed) one jin, bai mi (white honey) one jin, gou qi zi (wolfberry) one jin fried black. It is cooked in four copper pots (iron utensils are taboo; a copper spoon is used), simmered gently over low heat for six days and nights, strained, then simmered three more days, combined into one pot and reduced to a paste; the gui ban jiao, bie jia jiao, and e jiao (the three gelatins) are added, and fu ling, bai shao, lian zi, and qian shi are ground to fine powder and worked into the paste to form pills.
💬 Note from Doctor Luo: After finishing one batch, this man was greatly strengthened — his body grew strong. Why? At the start of the disease it was excess evil; but after seven years, his upright qi was depleted too. Fill the qi of the organs, and form and spirit unite — only then can the spirit return to its post. We will meet Zhuan Xi Da Sheng Gao many more times in Doctor Wu Jutong’s case records; it is his signature tonic formula, and its results are excellent.
The ending: at the next imperial examination, he actually PASSED
Now the most legendary ending of all: after his body recovered, at the next imperial examination — he actually passed! He passed!
💬 Note from Doctor Luo: A miracle, isn’t it? On the one hand, it shows his foundations were still there — sick for seven years and still able to pass. On the other hand, Doctor Wu Jutong truly cleared his mind. A madman chained to a millstone for seven years, who finally passed the imperial examination — in the ancient case records this is a rare and celebrated story.
Doctor Luo Dalun’s summary: three things most worth learning
The case is told; Doctor Luo Dalun marks the key points for his audience:
💬 Note from Doctor Luo: First, learn Doctor Wu Jutong’s “calibrating the sights” approach — probe the measure first; do not attack fiercely from the very start, and do not tonify wildly from the very start either. Second, learn his method of draining the small intestine in treating mania — the fire of the heart and gallbladder is sent out through the small intestine with the urine. Notice something from daily life: when you feel vexed, with yellow urine, a red tongue, red eyes — damp-fire in the liver and gallbladder — the Long Dan Xie Gan Wan (Gentian Liver-Draining Pill) you take starts with long dan cao too. The principle is exactly the same. Third, mental diseases must always be supported by strengthening upright qi in the later stage — that is exactly what Zhuan Xi Da Sheng Gao is for.
Finally, Doctor Luo Dalun adds one special reminder: these good things are for your understanding — please, do not brew the medicine at home by yourself. Many of the herbs in these formulas are not “food-medicine dual purpose” (bai shao, white peony, is not one of them), and under national regulations making your own medicine is against the law. A pharmacist once made classical Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) at home, and several government departments jointly enforced the law and took away his whole family. Food-medicine dual-purpose items you may handle; anything not on that list — don’t touch it. For friends overseas, if your conditions allow it, you are welcome to make it yourself.
💬 Note from Doctor Luo: A madman chained to a millstone for seven years — who finally passed the imperial examinations. That is the confidence of Chinese medicine. It reminds us: mental illness is not all “deficiency.” When fire must be drained, drain the fire — and the person wakes up. I hope this story can help more families troubled by mental illness.
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》, the mania section, Qing dynasty).