Hard Lump in the Stomach, Pain Pulling at the Flanks? Doctor Zhu Danxi Treats Accumulations (Ji Ju) with Da Cheng Qi Tang and a Halved Dose of Rhubarb
Patient search words: hard lump in the stomach / lump felt through the belly / pain pulling at both flanks / cold above the knees / unwell after walking in the great summer heat
Corresponding medical terms: ji ju (accumulations and gatherings) · zheng jia (palpable abdominal masses) · shi ji (food stagnation) · tan yin nei ting (phlegm-fluid retained internally) · damp-heat brewing internally
Opening scene: you touch your belly and find a hard lump — who wouldn’t panic?
The disease Doctor Zhu Danxi tells us about today makes many people nervous the moment they hear about it — a lump growing in the belly. Some patients only feel something blocking the way; others can actually feel it with their hands — a hard, firm lump sitting right in the abdomen.
💬 Note from Doctor Luo: In ancient Chinese medicine this kind of illness was called ji ju (accumulations and gatherings), also known as zheng jia (palpable masses). The moment modern people hear “a lump in the belly,” their first thought is a tumor. Of course, an accumulation in Chinese medicine must be distinguished from a tumor — but in the old case records, many of these “lumps” were actually phlegm-dampness, stagnant blood, or undigested food clumping together. They are formed, visible pathological products, and if the diagnosis and treatment are right, they can be dissolved.
Who was the patient? Sixty years old, walking in the midsummer heat
The patient was sixty years old — no longer young. Doctor Zhu Danxi always began his case records with the patient’s lifestyle: this elderly gentleman was fond of drinking wine.
💬 Note from Doctor Luo: Don’t underestimate those four words. People who drink regularly have bodies with their own characteristics — wine is fiercely hot in nature, so after years of drinking, damp-heat builds up inside, and phlegm-dampness accumulates easily as well. This is a key clue for the whole diagnosis that follows.
How did the illness begin? The case record says it in four characters: “yin xing shu zhong de ji” — he fell ill while walking in the scorching summer heat.
💬 Note from Doctor Luo: People today may not understand — how can you get sick just from walking on a hot day? In the old days there was no air conditioning, and the midsummer heat of the Jiangnan region could genuinely make people ill. Walking a long way under the blazing sun, with no water to drink, a person can suffer heatstroke — in severe cases it is truly life-threatening. This elderly gentleman was traveling in exactly that kind of weather and contracted the summer-heat pathogen (shu re zhi xie).
The symptoms: cold above the knees, and a big hard lump at the upper opening of the stomach
How far had the illness gone? First, cold above the knees; second, “shang wan you kuai ru zhang” — at the upper opening of the stomach, there was a lump as big as a palm; third, that lump pulled at both flanks and caused pain; fourth, he could not sleep, and his appetite had decreased. The one curious thing: he was not thirsty.
💬 Note from Doctor Luo: The shang wan is the upper portion of the stomach. A palm-sized hard lump blocking the upper opening of the stomach, pulling at the ribs on both sides with pain, unable to eat, unable to sleep — this elderly gentleman was genuinely seriously ill.
Doctor Zhu Danxi’s theory: where the lump sits tells you where the root lies
When Doctor Zhu Danxi discussed accumulations, he had a famous method of locating the problem: a lump in the zhong wan (the center of the body) is usually caused by phlegm-fluid (tan yin); a lump on the right side is usually food stagnation (shi ji) — food that was not digested and accumulated there; a lump on the left side is often dead blood (si xue) — stagnant blood blocking the area and slowly congealing into a mass.
💬 Note from Doctor Luo: Pay attention — Doctor Zhu Danxi emphasized that if it were only qi gathering, it could not form this kind of hard lump. Qi stagnation alone produces only an invisible, stuffy distension. Since a formed lump can already be felt, it must be connected with phlegm, stagnant blood, or retained food — the formed, material kinds of pathogens. So the treatment approach is very clear: “salty to soften it” (xian yi ruan zhi) — use salty herbs to soften the mass; “dispersion to dissolve it” (xiao yi xiao zhi) — use the dispersing method to melt it away gradually; and above all, move the qi and open the phlegm. He also had an important piece of experience: after the lump is dissolved, you must tonify greatly. It is because zheng qi (upright qi) was insufficient that qi and blood congealed into a lump in the first place — if you don’t restore the upright qi, the illness will return.
The patient treated himself first: three doses of Wu Ji San
This elderly gentleman knew a bit of medicine himself, so he first took Sheng Liao Wu Ji San (Raw Five Accumulations Powder) — three doses.
💬 Note from Doctor Luo: Wu Ji San is a ready-made formula from the Tai Ping Hui Min He Ji Ju Fang (Formulary of the Imperial Grace Pharmacy), made specifically for cold-dampness — it disperses cold-damp from the exterior and transforms accumulations and stagnation internally. Inside it are ma huang (ephedra) to disperse cold, and warming herbs such as rou gui (cinnamon bark) to warm the interior — it is a formula for cold patterns. Seeing that his knees were cold, the elderly gentleman decided he had yang deficiency with cold-damp, so he used it on himself. The result? It helped a little, but didn’t cure him — so at last he came to Doctor Zhu Danxi.
The diagnostic highlight: is cold always yang deficiency?
When Doctor Zhu Danxi took the pulse: all six positions were deep, choppy and small — yet strong when pressed; and the right pulse was especially pronounced. He also noted: stool normal, urine reddish, and the pulse was rapid.
💬 Note from Doctor Luo: This set of pulse signs is the most crucial line in the whole case. Deep, choppy and small means qi and blood are blocked by something and cannot circulate freely — it is not deficiency! A truly deficient pulse gives way when pressed; his pulse actually felt quite strong under the fingers. Add reddish urine and a rapid pulse — there is heat inside! The elderly gentleman looked only at the surface: cold knees — yang deficiency? Doctor Zhu Danxi looked at the whole picture: a lifelong fondness for wine, so damp-heat was heavy; walking in the summer heat, so he had also caught external heat. The heat from inside and outside joined in conflict, and on top of that the stagnation was blocking qi and blood — so the qi and blood could not reach the area above the knees, and that is why the man felt cold. Never assume yang deficiency just because a person feels cold — many cases of feeling cold are actually caused by qi and blood failing to circulate smoothly.
Breaking down the prescription: Da Cheng Qi Tang, with the rhubarb cut in half
The treatment strategy was settled: this was heat binding (re jie) and needed to be purged downward. Doctor Zhu Danxi prescribed Zhang Zhongjing’s Da Cheng Qi Tang (Major Order the Qi Decoction) — da huang (rhubarb), zhi shi (immature bitter orange), hou po (magnolia bark), mang xiao (mirabilite) — but he halved the rhubarb, because this patient’s bowel movements were still normal and there was no need for a violent purge.
💬 Note from Doctor Luo: Here is the beauty of it. Da Cheng Qi Tang is classically used for yang ming fu shi — heat pathogen injuring the fluids, bowels blocked. Since this patient’s stool was normal, the rhubarb was halved, and the formula was used only to purge the heat binding. But Doctor Zhu Danxi still worried that the formula might be too cold and injure the yang qi — so what did he do? He stir-fried the herbs, removing their cold, cooling nature! Then he added huang lian (coptis) to clear heat, shao yao (white peony) to unblock and harmonize the blood, chuan xiong (cnidium) to move the qi within the blood (shao yao and chuan xiong together — one pair that invigorates and harmonizes the blood), gan ge (kudzu root) to relax the flesh and free the channels, and gan cao (licorice) to harmonize everything. This is how meticulous Doctor Zhu Danxi was with his herbs.
The decoction purges food stagnation, the pills transform phlegm: two dosage forms, two jobs
Alongside the decoction, Doctor Zhu Danxi matched a pill formula: gualou ren (trichosanthes seed), ban xia (pinellia), huang lian (coptis) and bei mu (fritillaria) made into pills.
💬 Note from Doctor Luo: Gualou ren transforms phlegm and — above all — unblocks the large intestine; it is frequently used when the stool is dry and bound. Ban xia transforms phlegm, bei mu transforms phlegm, and huang lian clears heat. Why was the right pulse so pronounced? The right pulse governs food stagnation, and food stagnation almost always gets tangled up with phlegm. So the decoction purges the food stagnation, while the pills transform the phlegm — one attacks, one transforms, each dosage form takes care of its own job, with a clear division of labor. This was a favorite tactic of Doctor Zhu Danxi.
The twist in treatment: when the lump shrank by half, he stopped the medicine
The medicine was used for twelve days: the cold above the knees receded (the channels had opened and qi and blood were flowing again), and the hard lump shrank by half. At that point Doctor Zhu Danxi made a surprising decision — stop the medicine.
💬 Note from Doctor Luo: By ordinary logic, when a medicine is working you should press your advantage and keep using it until the lump is completely gone. Not Doctor Zhu Danxi. He treated illness with a strong sense of proportion: once the lump is half dissolved, the body can already solve the problem on its own — if you keep attacking, you will injure the zheng qi (upright qi). Stop, and let the body restore itself. And indeed, half a month later the illness was completely cured — the lump dissolved on its own. The body always had the ability to repair itself; earlier it was the phlegm-dampness and stagnation blocking it that prevented recovery. Now that most of the obstruction was cleared, the body could clean up the rest by itself.
The ancient rule: “reduce the greater part, then stop”
Doctor Zhu Danxi’s approach rested on a principle from the Huangdi Neijing (Yellow Emperor’s Inner Canon): “Da ji da ju, qi ke fan ye, shuai qi da ban er zhi” — for great accumulations and great gatherings, how dare one attack them recklessly? Reduce the greater part, then stop.
💬 Note from Doctor Luo: How should we understand this? When a person has a serious accumulation disease, the body is bound to be very weak. If you attack the pathogen — breaking up blood, dissolving stasis, freeing the channels, transforming phlegm, purging downward — too fiercely, the lump may dissolve, but the zheng qi is scattered too, and things get very difficult afterward. So the Neijing set down the rule: dissolve most of it and then stop, and leave the rest to the body’s own recovery. Later physicians observed this rule faithfully — Doctor Li Dongyuan’s prescriptions worked the same way: once the goal was reached, he stopped. Patients would chase him with money, begging: “I just want to keep taking this wonderful medicine!” Doctor Li Dongyuan would say: we’ve reached the point where we should stop — I won’t give it to you. Let the body recover slowly from here.
A little bonus knowledge: ji and ju are actually not the same
In Chinese medicine, ji (accumulation) and ju (gathering) are strictly speaking two different diseases. Ji is yin blood and yin qi congealing — fixed in one place, lurking and causing pain, forming a mass. Ju is yang qi gathering — it tends to move: today a lump swells up here, tomorrow one appears there.
💬 Note from Doctor Luo: When treating, you should keep them separate — distinguish yin from yang, qi from blood. But the common principle for both is: attacking the pathogen must be done with proportion.
Conclusion: the measure of attacking the pathogen is the whole point of studying this case
Why did Doctor Zhu Danxi place so much weight on proportion? Because he had personally learned the lesson from his own teacher — attack the pathogen without restraint, injure the zheng qi, and the harm is endless. So he always carried a scale in his heart: while you attack the pathogen, you must also weigh how much upright qi remains.
💬 Note from Doctor Luo: This is the sentence in this case record most worth remembering: when treating illness, you cannot keep your eyes fixed only on how fierce the pathogen is — you must also ask why the pathogen could exist in the first place. It is because zheng qi is insufficient that pathogens can gather. Attack the pathogen to a fitting point, then stop and let the body recover on its own. Especially when attacking the pathogen — be careful never to harm the upright qi by accident. That is the purpose of studying this case.
What to take away
Three things stand out from this case. First, a cold feeling is not automatically yang deficiency — this gentleman had damp-heat from wine, summer-heat from travel, and stagnation blocking his qi and blood; the cold above the knees was a sign of poor circulation, not a cold body. Second, where a lump sits points to its root: phlegm-fluid in the center, food stagnation on the right, dead blood on the left — and a formed lump always involves formed pathogens, so the treatment was to soften, disperse, move qi and open phlegm, with Da Cheng Qi Tang modified to purge heat binding without harshly attacking. Third, attack with proportion: dissolve the greater part, then stop, and let the body finish the job — because the root of every accumulation is insufficient upright qi, and if you scatter the upright qi, the disease will only return.
Based on Doctor Luo Dalun’s commentary on Doctor Zhu Danxi’s case records, from Zhu Danxi’s collected case studies (丹溪医案).