Whole-Body Joint Pain That Won’t Bend? Doctor Xue Lizhai Cures His Mother’s Bone and Joint Pain with Liuwei Dihuang Wan plus Zhizi and Chaihu
Patient search terms: whole-body aches / joint pain / bone and tendon pain / too painful to bend over / skin itching like insects crawling / dry mouth and red eyes
Medical terms for this condition: bi syndrome (painful obstruction) · bone and sinew pain · liver-kidney yin deficiency · hyperactive liver fire
Opening: three thousand case records, and he conquered them with just a handful of formulas
The physician in today’s story is, once again, Doctor Xue Lizhai, head of the Imperial Academy of Medicine in the Ming dynasty — personal name Ji, courtesy name Xinfu, style name Lizhai. He came from a family of imperial physicians and left behind more than three thousand case records over his lifetime. Doctor Luo Dalun calls him a strange man — strange in a very particular way: he treated his patients with just a few formulas, turning them over and over with small adjustments.
💬 Note from Doctor Luo: This is like a martial-arts master. In the beginning he learns all kinds of techniques; in the end, after years of practice, he practices only a few — but changes them constantly, with endless variations. That is Doctor Xue Lizhai: deep family learning, his father an imperial physician, the family strong in pediatrics and surgery. When it came to him, he settled on just a few formulas — but he used them with extraordinary precision. Look at those three thousand-plus cases: most of the patients were cured. Read through all three thousand cases and your understanding of these few formulas will be something quite out of the ordinary.
Who was the patient? Doctor Xue Lizhai’s own mother, aged 75
This patient was no stranger — she was Doctor Xue Lizhai’s own mother. The original text opens with four characters: xian mu qi shi you wu — "my late mother, seventy-five." "Late mother" means his mother had already passed away by the time he wrote his book; he was recording an illness she suffered in the year she turned seventy-five.
💬 Note from Doctor Luo: What was the illness? Pain all over the body, worst in the bones and sinews, unable to bend or straighten — biao shen zuo tong, jin gu you shen, bu neng qu shen. Pain over the whole body, and the sinews especially — the sinews being the connections between bones. The pain was so severe she could hardly bend or stretch. Imagine what a seventy-five-year-old person goes through with this illness — how painful it must be! And among elderly people today, this kind of joint and bone pain is extremely common.
How bad was it? Aches everywhere, plus itching like insects crawling
Whole-body pain alone wasn’t enough to make a diagnosis, so Doctor Xue recorded the other symptoms: dry mouth and red eyes — the mouth parched, the eyes bloodshot, as if there were fire inside; dizziness and phlegm congestion — a dizzy head and copious phlegm; chest and diaphragm discomfort — the chest felt blocked; scanty dark urine — little urine, yellowish in color, noticeably worse at night; and one more: itching all over the body as if insects were crawling on the skin.
💬 Note from Doctor Luo: The symptom of itching like insects crawling — we saw it in an earlier case, where it was caused by qi deficiency. In this case, Doctor Xue judged it to be caused by yin deficiency. The very same symptom can have completely different causes — this is the art of pattern differentiation in Chinese medicine. Later commentators summarized this case in eight characters: kidney water insufficient, liver fire in excess (shen shui bu zu er gan huo you yu).
Breaking down the prescription: replenish kidney water on one side, clear liver fire on the other
So what formula did Doctor Xue use? Very simple — the Liuwei Dihuang Wan ingredients (liu wei di huang wan liao), plus shan zhi zi (gardenia fruit) and chai hu (bupleurum). Note the character "liao" (ingredients): he did not use the ready-made pill. Instead he assembled all the medicinal herbs of the Six-Ingredient Rehmannia Pill — prepared rehmannia, cornus fruit, Chinese yam, water plantain, moutan bark, and poria — decocted them as a soup, and added the two extra herbs.
💬 Note from Doctor Luo: Shan zhi zi, as everyone knows, drains the fire of the san jiao, especially heart fire. Chai hu soothes the liver and regulates qi. Liuwei Dihuang Wan treats kidney water and nourishes yin. So this formula treats the kidney water on one side and clears liver fire on the other — once kidney water is replenished and liver fire is cleared, the two work together. What was the result? All symptoms resolved — every complaint was cured.
"All symptoms resolved" does not mean the disease was truly gone
But there is a subtlety here. When Doctor Xue’s case records say "all symptoms resolved," you have to listen carefully: it means the symptoms all disappeared — but the disease itself may not be truly cured.
💬 Note from Doctor Luo: Why? Because an elderly person’s constitution cannot be changed overnight. Take my own mother as an example — she has a yin-deficient constitution, exactly like Doctor Xue’s mother. I could cure her illnesses, but did her constitution change? No. The liver fire still flares up every day. So when Doctor Xue writes "all symptoms resolved," there is a deeper meaning in those words, and we need to learn to read it.
Why did such a serious illness yield to just a few herbs?
The illness looks severe: joint pain, inability to bend, dry mouth, red eyes, excess phlegm, dizziness, scanty dark urine… Why did Liuwei Dihuang Wan with a little gardenia and bupleurum cure it? Doctor Luo Dalun explains it clearly:
💬 Note from Doctor Luo: First look at the foundation — this elderly lady’s constitution was yin-deficient, with liver-kidney yin deficiency. Remember, when kidney yin is insufficient, it usually combines with liver yin deficiency — that’s why we call it liver-kidney yin deficiency. This was the foundation of her body. The dry mouth came from yin deficiency and depleted fluids. The scanty dark urine: yin deficiency does that, and so does fire. Now look at the liver fire — when liver fire blazes, the body’s fluids become insufficient. Fluids moisten and nourish the four limbs and hundred bones; when the fluids are depleted, the sinews and vessels have nothing to nourish them, and problems arise. The liver governs the sinews — the connections between bones are sinews. With liver yin insufficient and liver fire present, the sinews lose their nourishment, hence the whole-body pain, the bone and sinew pain, the inability to bend and stretch. And the red eyes? The liver opens into the eyes — when there is liver fire, the eyes turn red. The dizziness with phlegm and chest tightness came from liver fire moving upward and dragging the body’s dampness with it — dampness is not the same as usable fluids; dampness cannot be transformed into fluids the body can use, and the phlegm congestion and chest tightness all came from this. The scanty dark urine is also related to the liver channel’s course — when a person with liver fire has damp-heat pouring downward, the urine turns scanty and dark. It being worse at night is the yin deficiency. As for the itching like insects crawling — that comes from qi and blood failing to circulate and failing to nourish the body surface. A yin-deficient person’s tongue is always red, with a very thin coating or even no coating at all. When yin is insufficient, blood is insufficient, fluids are insufficient, and the body surface goes unnourished — so it itches. That is why an elderly person with qi deficiency can itch, and an elderly person with yin deficiency can also itch — you must always tell the two apart.
Elderly joint pain: don’t only think about external pathogens
Here Doctor Luo adds a warning of considerable weight:
💬 Note from Doctor Luo: When an elderly person’s joints hurt, everyone immediately thinks of external pathogens — wind-cold-damp, wind-damp-heat: the pathogen came, so the joints hurt. But you must always ask: why did the external pathogen come in at all? Many elderly people first have liver fire: a short temper, a tendency to get worked up. The liver fire burns inside, consuming the body’s fluids until they are nearly used up. With the fluids gone, nothing nourishes the sinews and vessels, and trouble begins at the sinews; by then the channel pathways inside are nearly empty, and external pathogens easily slip in. So in this kind of case you should consider the external pathogen — but even more, the internal cause: does this elderly person have liver fire? Is the constitution yin-deficient? All of this must be examined. Expelling pathogens is fine, but never forget to support the upright qi — forgetting to support upright qi is a mistake.
On the surface medicine treats the disease; underneath it is emotion and constitution
The illness was cured, yet Doctor Xue remained very cautious — a patient like this is actually hard to regulate. Why?
💬 Note from Doctor Luo: Elderly people with liver fire usually either ran into something, or their temperament is simply like that. And there is a vicious cycle at work: the more yin-deficient you are, the more easily liver fire flares; the more liver fire, the more yin-deficient the constitution becomes. I feel this deeply — it’s the story of my own family. My mother has a yin-deficient constitution and has suffered from it all her life. In her youth she was a strong-willed "tough woman": she couldn’t stand to see things out of place; if something wasn’t put away properly, she would go on and on about it until it was done. With that temperament, her liver fire was enormous and she was often angry; great liver fire easily produces yin deficiency; the more yin-deficient, the more fluids are lacking. My mother once suffered from rheumatoid arthritis, and it took me a long time to regulate it.
Bonus: the idea of taking Liuwei Dihuang Wan with gardenia-bupleurum water
Reading Doctor Xue’s case records, on the surface it is medicine treating the disease — but underneath it is really the problem of emotion and the problem of constitution. Once you know this, the thing to do is prevention.
💬 Note from Doctor Luo: Medication can be adjusted and symptoms can disappear, but you must know your own constitution — most people have no idea what theirs is. Once you know it, find the root and guard against it: for example, when liver fire is the issue and you feel anger rising, first silently count to one hundred, or recite a Buddhist mantra, and learn to "go with the flow." The moment you get angry, go outside and walk a circle — stop dwelling on it. Read more books on self-cultivation, and adjust yourself actively. Otherwise, once you enter old age with both constitution and temperament already set, it is truly hard to change. What we learn from this case: Liuwei Dihuang Wan can be paired with herbs that clear liver fire — make a decoction of shan zhi zi and chai hu and take Liuwei Dihuang Wan with it. This soothes the liver, regulates qi, and clears liver heat — a useful therapeutic idea. Who suits it? People with difficult emotions combined with yin deficiency: a pointed tongue tip, red and flushed, with a very thin tongue coating or none at all — for them, Liuwei Dihuang Wan plus a bit of gardenia and bupleurum works well. Sometimes I even pair it with Jiawei Xiaoyao Wan (augmented Free and Easy Powder) — but in this case the yin deficiency was quite pronounced, and Jiawei Xiaoyao Wan contains spleen-tonifying and mildly yang-supplementing ingredients, which would not have been right. Simply draining liver fire and clearing liver heat, then nourishing yin with Liuwei Dihuang Wan, is an excellent approach in itself.
Organized from Doctor Luo Dalun’s lecture explaining the case records of Doctor Xue Lizhai; the case comes from Records of Cases by Doctor Xue (《薛氏医案》).