Rheumatic Leg Pain That Stabs Every Time You Move?

What people search for: rheumatic leg pain / leg pain / rheumatism / chronic rheumatism / joints that ache and dart around / pain the moment you move

Medical terms: bi syndrome (painful obstruction; called tong feng in ancient times) · blood-deficiency arthralgia · rheumatic arthritis · internal heat combined with external cold

The opening scene: the “tong feng” Doctor Zhu Danxi talks about is not what you think

Doctor Zhu Danxi (朱丹溪) had his own way of naming diseases. At the very start of this lecture he gave his listeners a heads-up: the disease he was about to discuss, he called tong feng (痛风) — and he even wrote a whole essay on it, the Tong Feng Lun (《痛风论》, On Tong Feng). But this “tong feng” is not the same thing as what modern people mean by gout.

💬 Note from Doctor Luo: The “gout” people talk about today is the high-uric-acid condition where your big toe throbs. Doctor Zhu Danxi’s “tong feng” refers to rheumatic disease — the ancient bi syndrome (痹证, painful obstruction), especially the pain-dominated kind. He said the illness behaves like wind: sometimes it darts around from place to place, and it always hurts — so he named it “tong feng,” literally “painful wind,” and the name is actually quite vivid. Does it have anything to do with modern gout? A little — it counts as one category within it.

Before Doctor Zhu Danxi, wei syndrome (痿证, atrophy and weakness of the limbs) and bi syndrome (痹证, painful obstruction) were often muddled together and nobody could tell them apart clearly. Wei syndrome is the condition where the limbs are limp and cannot move. Doctor Zhu Danxi deliberately separated them: bi syndrome he called tong feng; wei syndrome stayed wei syndrome — and from then on the two were clearly distinguished.

Who was the patient? Old Mr. Fu of Dongyang — past sixty, quick-tempered, and always working

The story takes place in Dongyang (东阳) — Dongyang, Zhejiang, close to Doctor Zhu Danxi’s hometown, which is why so many of his patients came from that area. This patient’s surname was Fu (傅), he was over sixty years old, and in the case record Doctor Zhu Danxi wrote down his usual two notes about the man: “xing ji” (性急, quick-tempered) and “zuo lao” (作劳, hardworking and worn down by labor).

💬 Note from Doctor Luo: Notice how Doctor Zhu Danxi practiced medicine — he wrote down his patients’ temperaments, and later all of his analysis hinges on that. A quick-tempered person has liver fire; liver fire damages liver yin; when liver yin is insufficient, liver blood becomes deficient; and when liver blood is deficient, the blood of the whole body is deficient — that whole chain of reasoning rests on those two characters, “quick-tempered,” written at the very beginning. Doctor Zhu Danxi recognized very early that a person’s temperament and psychological state can cause disease — this was his pioneering insight, and later physicians never really carried it far enough. When we see a doctor today, how many of them write down the patient’s personality? The practice has been lost. And the phrase “zuo lao” tells us this old man worked hard and was worn out every single day. Only when you understand this background thoroughly can the disease truly be treated well.

How did he fall ill? Doctor Zhu Danxi first laid out a whole theory of disease

To understand this case you first need Doctor Zhu Danxi’s theory of disease causes. He said: when the qi and blood of the human body circulate normally, no disease arises; but the moment qi and blood go astray because of cold or heat, illness begins — blood congeals when it meets cold, and moves when it meets heat; that is the law.

And people are exposed to two kinds of injury, inside and outside: internal injury from the seven emotions (内伤七情) — for example, liver fire burning all day from emotional turmoil, qi stuck and knotted; and external injury from the six climatic excesses (外伤六气, liu yin) — for example, sudden weather changes and sharp drops in temperature. When inside and outside attack together, the speed of qi and blood movement is thrown into chaos.

💬 Note from Doctor Luo: Doctor Zhu Danxi said that in most cases it works like this: the blood has already “come to a boil” from internal heat — something is wrong inside first — and then the person wades into cold water, stands on damp ground, fans himself for coolness, or sleeps in a draft (涉冷水、立湿地、扇风取凉、睡觉当风). It is a sweltering day and you want to cool off — then the cool wind blows on you. This is what he called “cold striking from outside” (han leng wai bo, 寒冷外搏). Your blood was racing along, and suddenly the cold pathogen hits it: cold and heat clash (寒热交加), the qi and blood stagnate, congeal, and cannot move, and wherever they are blocked, it hurts. So this kind of rheumatism is very often caused by internal heat meeting external cold (内热外寒).

How bad was it? Both legs hurt so much that any movement was like a knife

What Old Mr. Fu was suffering from was severe pain in both legs — how bad? Any slight movement made the pain much worse (动则痛甚). This is a form of bi syndrome in which pain is the dominant feature.

💬 Note from Doctor Luo: I know this disease from personal experience. I live in Hainan, and sometimes when I drive in the heat I get sweaty, then stick my elbow out the car window. The wind blows on it, and before long I feel the joint start to ache — that is exactly what Doctor Zhu Danxi is describing: inside, the body is hot and about to sweat, the qi and blood are moving fast; then wind-cold attacks from outside, cold and heat interlace, the qi and blood rush to the spot and get stuck — and the pain begins. Lots of people sit right under an air-conditioning vent after sweating, the draft hits their shoulders, and that very night the shoulders start to ache — rheumatism has broken out.

What did Doctor Zhu Danxi think? The most crucial line in the whole case — “this also involves deficiency”

After taking the pulse, Doctor Zhu Danxi rendered his judgment: ci jian xu zheng (此兼虚证) — “this is tong feng, yes, but it also involves deficiency.” The deficiency is a shortage of blood (xue kui, 血亏). And his treatment principle, in one sentence: nourish the blood and warm the blood, and the disease will settle itself (补血温血，病当自安).

💬 Note from Doctor Luo: When the blood is insufficient, nourish it; and while nourishing, add something warming so the blood can actually move. Once the blood is sufficient and qi and blood circulation is restored, the disease naturally heals. Doctor Zhu Danxi’s approach is always to look at the person who is sick, not just at the sickness.

The prescription: Si Wu Tang as the base, one slice of ginger to scatter cold, one pinch of phellodendron to clear heat

The formula he wrote begins with the number-one blood-nourishing classic in Chinese medicine — Si Wu Tang (四物汤, the Four Agents Decoction): shu di huang (熟地, prepared rehmannia), dang gui (当归, angelica sinensis), shao yao (芍药, peony) and chuan xiong (川芎, ligusticum) — four herbs together that nourish the blood.

On top of this base he added: tao ren (桃仁, peach kernel), which nourishes the blood while opening up the pathways; chen pi (陈皮, aged tangerine peel), to keep the tonics from piling up undigested by helping the spleen and stomach transform things — it also resolves phlegm-damp; niu xi (牛膝, achyranthes), to tonify the liver and kidney and free the channels; and more gan cao (甘草, raw licorice) and shao yao (peony). The decoction was made with fresh ginger (生姜) — ginger is warming, and right now the qi and blood need a little warmth.

💬 Note from Doctor Luo: Si Wu Tang is the ancestral blood-nourishing formula, and women in particular really should know it. Sadly, in mainland China it is very hard to buy Si Wu Tang or its granule form in pharmacies; but overseas this stuff is basically sold as food — in the United States and in Taiwan, you find it in supermarkets, one sachet after another of women’s health drink, just like a beverage. This gentle, thousand-year-old treasure really should be brought into everyday life — the regulations should be relaxed and it should be promoted widely. What a pity that it isn’t.

The most ingenious touch came at the very end: after the medicine was decocted, he ground up a little Qian Xing San (潜行散, literally “Hidden Walking Powder”) and stirred it in, to be drunk warm. What is Qian Xing San? A single herb — huang bai (黄柏, phellodendron bark). What does huang bai do? It clears damp-heat from the lower burner.

💬 Note from Doctor Luo: You see, Doctor Zhu Danxi thought more richly than most: this disease has both cold and heat — cold and heat intermingled. There is heat inside and cold outside. So he used a warming herb to scatter cold (fresh ginger) and a cooling herb to clear heat (phellodendron) in the same formula, regulating both sides at once. This is an excellent model for treating bi syndrome. We don’t study this enough today — we either use all warming herbs or all cooling herbs (gypsum and the like), forgetting that when cold and heat are mixed, warming and cooling herbs can be used together. Many modern patent medicines and paste formulas (gao fang) actually follow this same logic, precisely because pure cold or pure heat alone does not work.

Thirty or forty doses later, the disease was gone

And the result? Thirty or forty doses (三四十贴), and the illness was cured. Doctor Luo says Doctor Zhu Danxi treated disease with great decisiveness: the formula had very few herbs — just a handful — and the direction was extremely clear.

💬 Note from Doctor Luo: This is what they mean by “taking the enemy general’s head from the midst of ten thousand troops” (wan ma jun zhong qu shang jiang ren tou) — you go straight in, resolve the main problem, and the disease is healed. Doctor Zhu Danxi was especially skilled at nourishing blood: when he saw blood deficiency, if there was cold he added ginger, if there was heat he added phellodendron — done. Many people fail to understand his case records, but if you study them carefully, the signature is unmistakable: the formulas are all extremely simple.

Bonus one: a blast of cold wind on a scorching day is the easiest way to catch rheumatism

The most valuable thing in this case is a special pattern Doctor Zhu Danxi pointed out: rheumatism from internal heat meeting external cold.

💬 Note from Doctor Luo: Everyone assumes rheumatism comes from getting chilled. But from what I have observed, a great deal of rheumatism is actually caught in summer: the weather is hot, the qi and blood are boiling, the pores are wide open — and then you go into an air-raid shelter or some cold cellar, or you sleep with the window cracked, and the cool wind blows right on you. Cold and heat clash, the qi and blood congeal in one spot, and the pain begins. When I was a child, the people who stayed in air-raid shelters for a few days and came out with rheumatism all got it exactly this way. Pure wind-cold in winter is actually rarer — that kind warms up and heals easily. So in very hot weather, do not suddenly expose yourself to cold wind — and especially do not blast cold air on one part of the body. It is exactly the same principle as the common cold: everyone sorts colds into wind-cold and wind-heat, and overlooks “cold wrapping fire” (寒包火, internal heat with external cold) — yet that is actually the most common type of cold. Rheumatism works the same way.

Bonus two: quick-tempered people tend to run short of blood

Doctor Zhu Danxi wrote “quick-tempered” at the very top of the case record — not for nothing.

💬 Note from Doctor Luo: A quick-tempered person has liver fire; liver fire damages liver yin; when liver blood is deficient and the blood is insufficient, external pathogens easily invade — because the channels are empty, and only then can the evil qi get in. People online have made lists of “what personality gets what disease,” and many don’t believe them — how could it be so mystical? But if you analyze it carefully, it all connects: personality affects the nervous system, affects the movement of qi and blood, and the body then tends to produce corresponding illnesses. Back in his day, Doctor Zhu Danxi was especially willing to counsel his patients psychologically and explain their illness to them — he taught people to settle their hearts, to nourish their minds, to keep family harmony. Prescriptions adjust the body; a system of thought adjusts the mind — that was Doctor Zhu Danxi’s complete therapeutic system.

Bonus three: fierce pathogen-expelling drugs are “robbing drugs” — nourishing the blood is the true path

Doctor Zhu Danxi also told a cautionary tale right after this case, and every rheumatism patient should remember it.

💬 Note from Doctor Luo: Someone sees a neighbor’s herbal wine, takes a few doses of some fierce wind-dispelling, cold-scattering medicine, and in a few days the pain is gone — is that a good thing? Doctor Zhu Danxi said: it depends on the person. If the body is genuinely deficient, and you hit it with violent wind-scattering, cold-dispelling, channel-opening herbs, the upright qi gets more and more damaged — this kind of drug he called a “robbing drug” (劫药, jie yao, from the word for robbery). Here is an analogy: a regiment has only 10 soldiers left, all old, weak and sick. Instead of replenishing their numbers, you order them to charge — all 10 are wiped out. Fierce herbs expel the pathogen, so for a few days there is no pain — but the evil qi actually hides deeper and deeper, and the person is wounded as well. There is a common failing in treating rheumatism today: we only emphasize dispelling wind, cold and evil — it works for a few days, then the pain returns. Why? Because we forgot to support the upright qi (fu zheng, 扶正)! Your blood was never replenished, the channels are still empty; the dispelling troops push the cold out, and a few days later the pathogen sneaks back in. Some people take blood-nourishing formulas — for example, women taking Yu Ling Gao (玉灵膏, Jade Spirit Paste) — and their joint pain heals. Why? Because the blood becomes sufficient, and the wind and cold pathogens get driven out by the body itself. Doctor Zhu Danxi used Si Wu Tang to nourish the blood, added peach kernel and achyranthes to free the channels, and as the upright qi gradually filled in, the pathogen left — and this time, it did not come back. That is “proper treatment” (正治), the true path: a little slower, a month or more before it is done, but after healing, the body is stronger than before. Taking the true path is the real wisdom.

Compiled from Doctor Luo Dalun’s lecture on Doctor Zhu Danxi’s case records. The case comes from Doctor Zhu Danxi’s treatise on tong feng, the Tong Feng Lun (《痛风论》).

What to take away

• Rheumatism is not only caused by cold — “internal heat meeting external cold” is a classic pattern. Heat makes the blood race; a sudden draft of cold wind makes it congeal on the spot, and that is where the pain begins. Do not blast cold air on your body — especially when you are hot and sweating.
• Look at the person, not just the disease. Doctor Zhu Danxi recorded “quick-tempered, hardworking” at the top of the case for a reason: temperament shapes qi and blood, and quick-tempered people tend to run short of blood.
• Nourish the blood instead of only attacking the pathogen. Fierce wind-dispelling drugs are “robbing drugs” when the body is weak — they push the evil deeper and injure upright qi. Nourish the blood, warm it, free the channels: the pathogen leaves on its own and does not return.
• Cold and heat can be mixed — so warming and cooling herbs can be used together. Fresh ginger for the cold outside, phellodendron bark for the heat inside, all in one formula: that is the two-sided art of treating bi syndrome.