Suddenly Shouting and Nearly Fainting in a Rage?

Patient search terms: fainting after anger / collapsing after a furious outburst / shouting and nearly passing out in a rage / phlegm clouding the heart / holding anger in and never letting it out

Medical names for this condition: phlegm reversal (tan jue) · phlegm clouding the heart orifices · liver fire carrying phlegm upward · qi depression transforming into fire

Opening: This illness was born from “holding it in”

Today’s story is about a woman whose illness was terrifying when it struck — she suddenly let out a huge shout, and almost fainted on the spot. But when Doctor Zhu Danxi was called in, he did not rush to talk about the disease. The very first thing he wrote down was this person’s personality.

💬 Note from Doctor Luo: Notice how Doctor Zhu Danxi begins by recording the patient’s physical state — qi shi, “replete qi”: she was a sturdy, robust sort of person, not the frail, Lin Daiyu type at all. Then he describes her temperament — duo nu bu fa, “often angry, but never letting it out.” Doctor Zhu Danxi treated the person, not just the disease. This is exactly why I value the study of emotion-driven illness so highly: when I first studied Chinese medicine I started with Doctor Zhu Danxi’s books, and one thing struck me immediately — how thoroughly he analyzed people’s emotions and personalities! Today, chronic illnesses — especially those nagging, lingering conditions that no doctor seems able to cure — almost always have a personality factor and a psychological factor buried in them, tangled up with the way people do things to themselves. After practicing Chinese medicine for a long time, when you really trace an illness back to its source, you find it is woven into a person’s temperament in countless ways.

Who was the patient? A hot temper with an iron lid on it

This woman was strong and full of qi — but she got angry very easily, flew into rages at the slightest thing. And yet, she could not let it out. Every bit of it stayed bottled up inside.

💬 Note from Doctor Luo: This is exactly the type to worry about. Some people have bad tempers but they vent — they blow up, they shout, and actually feel a bit better afterwards. What frightens us is the one who never vents, who swallows every ounce of anger. That qi stays trapped in the chest, day after day, and nothing injures the body more. This woman was exactly that sort — she endured, and endured, until one day she simply could not hold it together any longer.

How sick did she get? One day the lid blew off — she cried out and nearly died

Hold it in long enough, and there is always an eruption. One day, something set her off — and this time the rage was ferocious. The case record says “jiao er yu jue”: she screamed and howled at the top of her lungs, and then nearly fainted — her life hanging by a thread, swaying, about to collapse to the ground.

The family was terrified and sent urgently for Doctor Zhu Danxi. The moment he saw her, he knew exactly what this was — phlegm reversal (tan jue).

💬 Note from Doctor Luo: Doctor Zhu Danxi’s professional diagnosis is summed up in eight characters: “tan bi yu shang, huo qi yu xia” — phlegm obscures the upper body, fire rises from below. This woman was robust, ate well, and carried a heavy load of phlegm-dampness in her body. People with lots of phlegm tend to develop strange illnesses. This time, in her fury, liver fire shot upward from below, “whoosh” — and slammed the phlegm straight up with it. Phlegm clouded the clear orifices — the heart orifices were masked, the mind went haywire, and she nearly fainted. Fire below, phlegm shoved to the top: that is the whole mechanism of the attack.

First formula: regulate the qi first, with Xiang Fu leading the charge

How to fix it? Doctor Zhu Danxi said it was not difficult. He first wrote a decoction with Xiang Fu (cyperus) as the main herb, plus two or three qian (about 6–9 g) of raw Gan Cao (licorice), together with Chuan Xiong (ligusticum).

💬 Note from Doctor Luo: Xiang Fu is the classic herb for regulating qi and resolving depression. Doctor Zhu Danxi said it “runs sideways and spreads out” (heng xing xuan jie), scattering the qi. Whenever he treated qi depression, Xiang Fu was his go-to herb — it is the most important medicine in his whole approach to soothing the liver and unblocking depressed qi. Here the liver qi was constricted and the liver fire was blazing, so the first task was to loosen the qi — hence he opened with a qi-moving herb. Gan Cao harmonizes and settles the middle burner. Chuan Xiong also regulates qi, and on top of that it nourishes the liver blood, helping the liver qi stay in its proper lane instead of charging around wildly — a way of reining the liver qi in.

The secret of child’s urine: drains fire and transforms stasis — Doctor Xue Lizhai once asked the Ming army about it

The most unusual part of this prescription is that it was cooked in tong bian — a child’s urine — and, on top of that, mixed with ginger juice.

💬 Note from Doctor Luo: Why child’s urine? First, tong bian itself drains fire — and it does so quite well. Second, tong bian also transforms stasis. There is a famous story here: the Ming-dynasty imperial physician Doctor Xue Lizhai once asked the Ming army how they treated their wounds. The soldiers said: when you are injured, drink child’s urine right away — that is how they dissolved the stasis. And why soak the Xiang Fu in tong bian? Because Xiang Fu is a somewhat drying herb; after being steeped in tong bian it becomes much more moist and gentle, losing that harsh dryness. The ginger juice is there because these herbs are quite cold — the fear was that coldness would trap the phlegm inside. Ginger juice counteracts the cold and helps transform phlegm — a “reverse-assistant” so the formula does not turn too cold.

Second formula: Ren Zhong Bai with Xiang Fu, a specialist for draining liver fire

Alongside the decoction, Doctor Zhu Danxi added a pill: Ren Zhong Bai (human white — urinary sediment) ground together with Xiang Fu powder, formed into pills.

💬 Note from Doctor Luo: The decoction in front, the pills behind. What does Ren Zhong Bai do? It drains liver fire — and it does so exceptionally well. What exactly is it? It is one of the strangest medicines in Chinese medicine: in the old days people used chamber pots, and year after year the urine left a layer of white crystalline crust on the wall of the pot. That crust was scraped off, processed, and became Ren Zhong Bai — a medicine made from human urine, excellent at draining fire. Combined with Xiang Fu powder into pills, it drained the liver fire on one side while smoothing the qi on the other.

The climax: one enormous vomit, and the phlegm was gone

After a while she was a little better. Then Doctor Zhu Danxi made a bold decision — he made her vomit. A great, wrenching vomit, and out came the phlegm.

💬 Note from Doctor Luo: Why vomiting? Phlegm was clouding the clear orifices — the pathogen was lodged up above, so it had to be expelled from above. This is the emetic method (tu fa) that Doctor Zhu Danxi excelled at. A couple of days ago on my Weibo I was talking about this: Chinese medicine traditionally had three methods — sweating (han), vomiting (tu), and purging (xia). We still use the sweating method all the time, but vomiting and purging are used less and less. Why? Patients cannot take it — especially vomiting. If you insist someone vomit, some patients simply cannot bear it. People today panic at the slightest reaction to a medicine, wondering if the prescription was wrong — when in fact that reaction is often a good sign: the medicine’s qi is surging against the blockage, so of course there is a response. A method like vomiting, which pushes the pathogen out through the top, is even less acceptable to modern patients. But in the Jin-Yuan era it was completely routine — another great master, Zhang Zihe, used the three methods of sweating, vomiting, and purging on nearly every patient he saw. It is a real pity that this approach has almost died out today. Doctor Zhu Danxi himself, when treating his own teacher’s illness, used beef to induce vomiting — once all the accumulated phlegm was vomited out, the illness was cured.

This woman, with her heavy phlegm and her sturdy qi, was the perfect candidate for the emetic method. After one tremendous vomit, she was basically stabilized — calm, and out of danger.

Aftercare: one decoction and one pill — first transform phlegm, then drain fire

But Doctor Zhu Danxi was not finished. He prescribed two more things: a decoction of Dao Tan Tang (Phlegm-Conducting Decoction) with ginger-fried Huang Lian (coptis) and Xiang Fu, to be followed by Dang Gui Long Hui Wan (Angelica and Gentian Pill) taken down with ginger soup.

💬 Note from Doctor Luo: This is where Doctor Zhu Danxi’s meticulousness shows. The crisis had passed, but the phlegm inside had not necessarily all cleared. What is Dao Tan Tang? It is Er Chen Tang (Two Matured Substances Decoction) with Zhi Shi (bitter orange) and Tian Nan Xing (arisaema) added. As you may know, Er Chen Tang with Zhi Shi — and then with Zhu Ru (bamboo shavings) added on top — becomes Wen Dan Tang (Gallbladder-Warming Decoction). Dao Tan Tang, by contrast, adds Tian Nan Xing, which transforms wind-phlegm, plus Zhi Shi to break up stagnant qi — greatly strengthening the phlegm-transforming power. It is the formula for conditions like phlegm reversal where phlegm is extremely heavy; some practitioners even use it for severe phlegm-based mental illnesses. Adding ginger-fried Huang Lian and Xiang Fu clears heat and moves qi. Huang Lian is very cold, so frying it with ginger softens the coldness without interfering with its phlegm-transforming role. And Dang Gui Long Hui Wan is another of Doctor Zhu Danxi’s own creations, whose main job is to drain liver fire — inside it, Chai Hu (bupleurum) and Qing Pi (green tangerine peel) soothe the liver and break depressed qi, Huang Lian and Da Huang (rhubarb) drive the heat downward, Dang Gui (angelica) nourishes the liver blood, Mu Xiang (costus root) moves the qi, Chuan Xiong pairs with Dang Gui to nourish and invigorate the blood, and Long Dan Cao (gentian) with Lu Hui (aloe) drain the liver fire. The Dang Gui Long Hui Wan sold in pharmacies today is the very formula handed down from Doctor Zhu Danxi’s books.

The decoction-and-pill pairing hides a serious principle

Did you notice? Both in treatment and aftercare, Doctor Zhu Danxi used a decoction and a pill together — and he did it by a rule: the phlegm-transforming, qi-regulating work went into the decoction; the liver-fire-draining work went into the pill.

💬 Note from Doctor Luo: Why be so particular? Phlegm is a thick, sticky fluid, and it lives everywhere. The decoction goes in first and dissolves the phlegm; the pill acts slowly, so by the time it kicks in, the phlegm is already loosened and the liver fire can be drained at leisure. If you drained the fire first with cold herbs while the phlegm was still there, the cold would seize the phlegm and congeal it inside — it would never dissolve. The ancients said “tan fei wen bu hua” — phlegm does not transform without warmth. You need some warming action or the phlegm will not move. So: transform the phlegm first, drain the fire second — the order must not be reversed. Look how carefully Doctor Zhu Danxi handled this: Xiang Fu cooked in child’s urine with ginger juice at the front; Huang Lian always ginger-fried at the back; Dang Gui Long Hui Wan washed down with ginger soup. He was using cold herbs to drain fire, yet at every step he guarded against excessive coldness injuring the yang qi or congealing the phlegm. Some people claim Doctor Zhu Danxi only knew how to drain fire and nourish yin and never protected yang qi — that is simply wrong. Every true master became a master precisely because he prescribed with immense care and protected the patient’s yang qi.

The finishing touch: the classic pairing of Zuo Jin Wan

Speaking of draining fire, Doctor Zhu Danxi left behind one more celebrated formula in this field — Zuo Jin Wan (Left Metal Pill) — and you can still buy it today as a ready-made medicine.

💬 Note from Doctor Luo: Zuo Jin Wan drains liver fire. How is it composed? Huang Lian (coptis) in the largest amount, draining heart and liver fire; and because Huang Lian alone would be too cold, a little Wu Zhu Yu (evodia) is added to warm the liver. The classic ratio is six parts Huang Lian to one part Wu Zhu Yu — six to one. Why warm the liver while draining its fire? As a counterbalance — if you drain fire with pure coldness, the result is poor. With a touch of Wu Zhu Yu, you drain the liver fire while keeping the liver warm, preventing the fire-draining from damaging the liver’s vitality — because the liver is an organ that must keep growing and springing upward. This pairing is one of the most classic combinations taught in Chinese formula studies; study at any TCM university and you will learn Zuo Jin Wan. When most of us think of draining fire, we picture a wall of cold herbs — but no: Doctor Zhu Danxi counterbalanced with a single warming herb, and the effect was far better than cold herbs alone. That is the mark of a master. One small case record, a handful of formulas, each decoction and pill used for a different purpose — savor it slowly, and you will see how technically rich it is. Practitioners of Chinese medicine can absorb this way of thinking from Doctor Zhu Danxi; it is a precious legacy the ancients left us.

What to take away

• The illness came from anger that was never expressed. A robust body with a hot temper is one thing — but a temper that never vents, anger swallowed day after day, is what really wounds. The qi gets trapped, the fire builds, and one day the whole thing erupts at once.
• The mechanism was “phlegm obscuring above, fire rising below.” In someone full of phlegm, a violent surge of liver fire can shove the phlegm upward and cloud the mind — shouting, confusion, near-fainting. Doctor Zhu Danxi read the person first: sturdy constitution, suppressed rage, and he knew.
• Treat in the right order: move qi, transform phlegm, then drain fire. First the qi was loosened with Xiang Fu; then the phlegm was expelled from above with the emetic method; only afterwards were the liver fire and residual phlegm cleared with Dao Tan Tang and Dang Gui Long Hui Wan. Cold herbs to drain fire too early would have frozen the phlegm inside.
• “Phlegm does not transform without warmth.” At every step Doctor Zhu Danxi used ginger — ginger juice in the decoction, ginger-fried Huang Lian, ginger soup to take the pill — protecting the yang qi while clearing heat. Even the famous Zuo Jin Wan pairs cold Huang Lian with warm Wu Zhu Yu at six to one.
• Today’s chronic, hard-to-cure illnesses are full of emotional causes. When a nagging condition will not heal no matter what, ask what the person has been holding inside.

Based on Doctor Luo Dalun’s interpretation of the case records of Doctor Zhu Danxi (Yuan dynasty).