Joint Pain So Severe the Neighbors Were Scared? A Case of Bloody Dysentery That Turned into Rheumatic Pain

What people search for: joint pain / gout / rheumatic joint pain / pain in the limbs and joints / dysentery with blood / pain so bad you scream

Medical terms: bi syndrome (painful obstruction, called tong feng in ancient times) · evil blood entering the channels · rheumatic pain · bloody dysentery

The opening scene: this patient hurt so badly the neighbors were afraid

Doctor Zhu Danxi (朱丹溪) loved to begin a lecture by explaining the name of the disease. This time the disease he was talking about is one he called tong feng (痛风) — but let me be clear from the start: Doctor Zhu Danxi’s “tong feng” is not the same thing as what modern people mean by gout. Modern gout is high blood uric acid and a throbbing big toe. What Doctor Zhu Danxi called tong feng refers to rheumatic obstruction — the whole family of limb-and-joint pain that arises when something goes wrong with qi and blood. Of course, it does overlap a little with today’s gout, and today’s case will show you exactly where.

💬 Note from Doctor Luo: Doctor Zhu Danxi had a hallmark way of practicing medicine — he paid tremendous attention to the patient’s upright qi (zheng qi, 正气). In every prescription he wrote, he was measuring how much upright qi the person had left: what should be tonified, he tonified; what absolutely should not be tonified, he refused to touch. Today’s story is a classic example of him holding that measure perfectly.

The hero of the story is Bao Liu (包六), the young man next door to Doctor Zhu Danxi, just over twenty years old — a vigorous young man in the prime of life.

Who was the patient? A bout of bloody dysentery that astringent medicine sealed back inside

Bao Liu’s illness began with bloody dysentery (xue li, 血痢) — dysentery, diarrhea, and in his case with actual blood coming out. That is a very serious condition.

The correct approach to dysentery is to clear the toxin and, depending on the situation, help the pathogenic qi get out. But the doctor who saw him first looked at how violently he was purging, felt sorry for him, and wrongly prescribed astringent, binding herbs. Once those went in, the torrent of diarrhea stopped and the patient looked “better” — but all the pathogenic qi was sealed inside the body. This was a mistake with very serious consequences.

💬 Note from Doctor Luo: Dysentery is rarely treated with astringent herbs — only at the very end, when the person is so depleted they cannot go on. Especially in the early stage of dysentery, you must never use astringent, binding herbs. The moment you do, the diarrhea stops and it looks like recovery — but the heat toxin is trapped inside, and the trouble that follows never ends. The astringents commonly used in the old days were ying su ke (罂粟壳, opium poppy husk) and he zi (诃子, chebula fruit) — all binding herbs. The stool stops, the disease seems cured, but the heat toxin stays buried in the body.

Sure enough, not long afterward, Bao Liu came down with tong feng — his joints began to ache, and the pain in his limbs and joints grew so fierce that he screamed out loud. His screams were so loud that the neighbors could hear them through the walls, and it frightened them. A strong young man in that much agony — imagine how terrible it was.

What did Doctor Zhu Danxi think? The most crucial line of the whole case — evil blood entering the channels

Doctor Zhu Danxi was called in, examined him, and delivered his judgment: this is the pattern of evil blood entering the channels (e xue ru jing luo zheng, 恶血入经络证).

What does that mean? Doctor Zhu Danxi explained: back then, the toxin of the dysentery was never expelled. The damp-heat toxin stayed inside the body and worked its way into the channels. Blood attacked by damp-heat, left for a long time, inevitably congeals and can no longer circulate normally. Those spoiled, evil bloods (e xue, 恶血) — mixed with damp-heat — clog the passages of the channels. When the passage is open there is no pain; when it is blocked, there is pain — so the pain cut to the bone.

💬 Note from Doctor Luo: Everyone, pay attention: if this disease goes untreated for a long time, the pathogen inside can trigger far more serious consequences — it can become pian ku (偏枯, hemiplegia), one-sided paralysis! So never underestimate a dysentery that was not properly cleared. The aftermath can be terrifying.

The prescription: Si Wu Tang as the base plus peach kernel and safflower — Tao Hong Si Wu Tang

Once the disease was understood, the formula followed. Doctor Zhu Danxi’s approach was the one he always favored: nourish the blood. He built the prescription on Si Wu Tang (四物汤, the Four Agents Decoction) — shu di huang (熟地, prepared rehmannia), dang gui (当归, angelica sinensis), bai shao (白芍, white peony), and chuan xiong (川芎, ligusticum) — the number-one formula for nourishing and regulating the blood. On top of that he added two blood-moving herbs: tao ren (桃仁, peach kernel) and hong hua (红花, safflower).

Si Wu Tang plus peach kernel and safflower is the famous Tao Hong Si Wu Tang (桃红四物汤, Peach Kernel and Safflower Four Agents Decoction). Do you know where this formula comes from? It was written down in Doctor Zhu Danxi’s own books.

💬 Note from Doctor Luo: Today, whenever women need to regulate their bodies, Tao Hong Si Wu Tang is everywhere — for anyone who is short of blood and also has blood stasis, you use Si Wu Tang to nourish the blood and add peach kernel and safflower to move the blood. Nourishing and moving at the same time, the body gradually returns to normal. When there is blood deficiency plus blood stasis, I often suggest soaking the feet in Tao Hong Si Wu Tang. This formula was handed down from Doctor Zhu Danxi.

Doctor Zhu Danxi’s signature insight: always add one piece of aged tangerine peel to your tonics

But the formula did not stop there. Doctor Zhu Danxi then adjusted it to the patient’s specific situation. He added niu xi (牛膝, achyranthes) — to strengthen the sinews and bones, tonify the liver and kidney, free the channels and drive out wind-dampness. He added huang qin (黄芩, scutellaria root) — to clear heat, because this particular patient had heat toxin retained inside the body. Joint pain comes in many flavors: cold, cold-damp, wind-cold-damp, and damp-heat. This patient was the damp-heat type with heat toxin mixed in.

And then came the key move: he added one piece of chen pi (陈皮, aged tangerine peel).

💬 Note from Doctor Luo: This is a signature insight Doctor Zhu Danxi used over and over: when you prescribe tonics, often add a piece of aged tangerine peel. Chen pi resolves phlegm and moves qi — I am tonifying you from the inside, but if your body is blocked and your qi and blood are not flowing, the tonics cannot get in. Many people get “heat” symptoms the moment they take tonics — a lump here, a flare-up there. Why? The tonic never got in; the channels were not clear. Adding chen pi opens the qi so that once qi and blood move freely, the tonic can ride the circulation to every corner of the body instead of piling up in one spot. Tonify without stagnation (bu er bu zhi, 补而不滞) — those four characters are Doctor Zhu Danxi’s unique skill.

He also added a little raw gan cao (生甘草, licorice) to harmonize the whole formula, and one slice of sheng jiang (生姜, fresh ginger) — because where there is congealing and stasis, a little warmth helps melt it open so everything moves more easily.

Cold and heat together: phellodendron clears heat, wine frees the channels

There was one more special ingredient in the formula — Qian Xing San (潜行散, literally “Hidden Walking Powder”). What is it? A single herb: huang bai (黄柏, phellodendron bark), ground into powder. When taking the decoction, the powder was sent down with a small amount of wine.

What does huang bai do? It clears damp-heat — especially damp-heat in the lower burner, where it works particularly well. Back in Doctor Li Dongyuan’s day, zhi mu (anemarrhena) and huang bai were already favorites; by Doctor Zhu Danxi’s time, he had become especially skilled at using huang bai to clear damp-heat.

💬 Note from Doctor Luo: Look at this formula: fresh ginger warms the qi and blood and scatters cold; huang bai and huang qin clear heat — cold and heat are used together. The little bit of wine adds power to free the channels. And the whole formula is built on tonification: Si Wu Tang nourishes the blood at the base, peach kernel and safflower move the blood, chen pi moves the qi, huang qin and huang bai clear heat, and ginger with wine warm the channels. Someone might ask: didn’t you just say heat toxin is retained inside? Then why are you tonifying? — This is exactly the most crucial part of Doctor Zhu Danxi’s way of practicing medicine.

The disease is this severe — so why tonify? Because a long illness always ends in deficiency

Why did Doctor Zhu Danxi build the prescription on Si Wu Tang to nourish the blood? Because he was treating the person, not just the disease. Think about it: this man had dysentery so severe it was bleeding. Was his upright qi strong or not? For a pathogen to stay in the body this long, the upright qi must already be too weak to push it out — if the upright qi were strong, it would have expelled the pathogen long ago.

💬 Note from Doctor Luo: A prolonged illness always ends in deficiency (jiu bing bi xu, 久病必虚) — that is the general rule. A pathogen that has lingered in the body this long is not only hard to drive out; it keeps draining your qi and blood day after day. So watch how Doctor Zhu Danxi worked: nourish the blood on one hand, clear damp-heat on the other, free the channels as well — expel the pathogen on the foundation of supporting the upright qi. Once the upright qi is sufficient, the garbage can slowly be pushed out. That was his greatest trait: he never stopped watching the person, always measuring how much upright qi was left.

At this point, Doctor Luo could not resist telling a story from his own early days in practice. When he was young, just starting to see patients at a small TCM clinic in his hometown, he took on a child with chronic nephritis and nephrotic syndrome. The child had been hospitalized in the Western-medicine hospital; when steroids were hammered in, the protein in the urine dropped; but the moment the steroids were withdrawn, the condition rapidly relapsed. The child’s face was wax-yellow. The Western doctors thought his liver must be diseased, but every test came back normal. In the end they could not withdraw the steroids, and the family came knocking.

💬 Note from Doctor Luo: At the time I thought: with kidney disease this severe, there must be blood stasis and damp-heat in the kidneys — so I moved the stasis and cleared the damp-heat. But the medicine had no effect. That child’s face was so yellow there was not a trace of life in it; everyone who saw it scratched their head. I was still puzzling when a teacher from Liaoning University of Traditional Chinese Medicine who happened to be there said: “The disease has gone on this long — the excess aspect is probably mild by now. Shouldn’t the deficiency of upright qi be the main problem? Does he still have that much upright qi left?” That struck me like a bolt of lightning: this child was now obviously deficient! I changed course immediately — forget the kidney stasis for now, first restore his spleen-stomach function and rebuild his qi and blood state. I prescribed Gui Pi Wan (归脾丸, Restore the Spleen Pill) and told the family to withdraw the steroids slowly at home while taking it: for every bit of steroid reduced, add one more pill of Gui Pi Wan. Before long the child came back, and the yellow was already gone from his face — he had returned to normal. A whole corridor of people came out to look, everyone was overjoyed. Seize the main contradiction and the result shows up immediately.

The same joint pain, but one patient gets no tonics at all — the master’s sense of measure

Of course, Doctor Zhu Danxi did not tonify everyone he met. Doctor Luo had told his listeners earlier about a woman in her thirties who ate rich, fatty, sweet food (fei gan hou wei, 肥甘厚味) every day, and had a hot, impatient temperament (zao ji, 躁急). She also developed tong feng — her elbow hurt for months, and no treatment helped. When Doctor Zhu Danxi examined her, he saw: this was phlegm and qi stagnation (tan qi yu jie, 痰气郁结), with blood stasis inside — so he moved the blood stasis, resolved the phlegm, and regulated the qi, and she gradually recovered. In that formula he did not add a single blood-nourishing herb.

💬 Note from Doctor Luo: Why no tonics for her? That woman ate rich food every day, was probably heavy-set, and had a hot temper — she was an excess pattern (shi zheng, 实证). Bao Liu in today’s case is a deficiency pattern (xu zheng, 虚证). In deficiency, Doctor Zhu Danxi saw insufficient upright qi and supported it; in excess, he did not tonify at all — he only regulated qi, resolved phlegm, and moved stasis. Watch how finely he held the measure. When we study great physicians, this is what we should look at: what was going through their minds, how they held the measure. That is the hand and eye of a master.

Nearly three he of black blood released — and the man was completely cured

For Bao Liu’s illness, Doctor Zhu Danxi’s decoction was used for several dozen doses (shu shi tie) — dozens of bowls of medicine. And then came one last move: bloodletting at Weizhong (委中穴, BL40). Where is Weizhong? In the crease at the back of each knee. The needle went in, and nearly three he (合) of black blood came out — a considerable amount of dark blood.

Once the stagnant blood inside had been drained, the man was completely cured.

💬 Note from Doctor Luo: Notice how the black blood released here echoes the poisonous blood that was “sealed” inside by the astringent herbs back during the bloody dysentery. The heat toxin that was never expelled back then had turned into stagnant blood in the body. Bad blood must have a way out — once it is released, the disease is cured. Decoction plus bloodletting, several therapies working together: Doctor Zhu Danxi never used one single method to the end. He deployed every tool of Chinese medicine flexibly according to the patient’s condition, and he mastered them all.

Two lessons you must remember

From this case we can learn two things.

First: for dysentery caused by heat toxin, never use astringent herbs in the early stage. Astringents like ying su ke (opium poppy husk) and he zi (chebula fruit) stop the diarrhea — but they seal the heat toxin inside. Especially in the early stage of dysentery, you should push the pathogen out as much as possible: clear the toxin and expel it at the same time, and only then can the person recover. Of course, dysentery can also be cold-type — cold-type dysentery needs warming yang — but the toxin must still be expelled as much as possible.

Second: when an external pathogen remains in the body and works its way into the channels, it causes blood stasis that blocks the passages of the channels. How do you fix it? Doctor Zhu Danxi established the approach for us: on the foundation of supporting the upright qi — if there is damp-heat, clear the damp-heat; if there is cold, warm it. This line of thinking is extremely important.

Modern insight: gout is “garbage” that cannot be expelled — supporting upright qi is the root

At the end of the lecture, Doctor Luo brought the case back to modern times — why can Doctor Zhu Danxi’s formula treat today’s gout?

💬 Note from Doctor Luo: Today we test blood and find uric acid is high. What is uric acid? It is waste that should be expelled. You did not expel it, so it stays in the body, disrupts the movement of qi and blood, and when the pain hits, gout flares up — fingers and bones can even deform. What should you do? Do not fixate only on expelling damp-heat. After you push the waste out, if your upright qi is still insufficient, the new garbage you take in every day still cannot get out. And diet alone is not the answer either — not eating certain foods is temporary; the moment you eat them again, the level climbs right back. So there is an approach called supporting the upright qi (fu zheng, 扶正): when the upright qi is sufficient, the body can slowly push the garbage out by itself. Think of Wu Ji Bai Feng Wan (乌鸡白凤丸, Black-Bone Chicken and White Phoenix Pill) — many people assume this is a gynecological medicine. I say it does not care about gender: the black-bone chicken in the formula can be taken by men or women; every single herb in it can be taken by either sex — so why, when combined, should it be only for women? It is actually a formula for supporting upright qi. And on top of supporting upright qi, adding a little damp-heat-clearing medicine is of course even better.

So remember: the tong feng Doctor Zhu Danxi talked about covers far more than modern gout — it includes the whole family of rheumatic bi syndrome. And the core of his treatment is always: first build the upright qi until it is full, then the pathogen can be driven out. Support the upright, add a little pathogen-expelling medicine on top, and the patient recovers — that is the most valuable part of today’s case.

Compiled from Doctor Luo Dalun’s lecture on Doctor Zhu Danxi’s case records.

What to take away

• Never astringe early-stage dysentery. Binding herbs like opium poppy husk and chebula fruit stop the diarrhea but seal the heat toxin inside — and that toxin can later turn into stagnant blood that causes joint pain, or worse, hemiplegia.
• A long illness always ends in deficiency. When a pathogen lingers because the upright qi is too weak to expel it, the treatment must support the upright qi first — then clear damp-heat and free the channels on top of that foundation.
• Tonify without stagnation. Doctor Zhu Danxi’s signature move: when prescribing tonics, add a piece of aged tangerine peel (chen pi) so the qi moves and the tonics actually reach where they are needed instead of piling up.
• Cold and heat can coexist — so use warming and cooling herbs together. Fresh ginger warms and scatters; phellodendron bark (huang bai) and scutellaria (huang qin) clear heat; a little wine frees the channels. And when stagnant blood is the problem, bloodletting at Weizhong (BL40) gives the bad blood a way out.