Stroke with a Contracted Arm, Choking on Water, Unable to Speak? Doctor Wu Jutong’s Case: The Pungent-Cool Method of Opening the Water Passages

Patient’s search words: stroke / hemiplegia / arm curled up and unable to move / choking when drinking water / unable to speak / difficulty swallowing / stiff tongue Medical terms: wind-stroke · wind-stroke with phlegm (phlegm-heat obstructing the interior) · contraction of the limbs · impaired speech · swallowing disorder

Opening: a 68-year-old woman whose left side “curled up”

One day in the Qing dynasty, an old woman surnamed Tao was brought in to see a doctor — sixty-eight years old, a very great age in an era when “few people live past seventy.” Her illness was unmistakably a stroke: her left arm and leg were all curled up, unable to straighten, unable to move.

💬 Note from Doctor Luo: Let me first introduce this physician — Doctor Wu Jutong, the great Qing-dynasty doctor and the culmination of the warm-pathogen (wen bing) school. His Tiao Bian (Systematic Differentiation of Warm Diseases) is honored as one of the four great classics of Chinese medicine. In the realm of cold damage there is Zhang Zhongjing; in the warm-pathogen school, only Wu Jutong produced such a systematic work. Ye Tianshi wrote very few words, very tersely; Wu Jutong explained the warm diseases from beginning to end — a tremendous contribution. He was extraordinary at treating externally contracted diseases, but the cases we are reading today are his records of internal medicine, of internally damaged diseases.

How bad was it: the tongue retracted, unable to speak, not a drop of water would go down

Doctor Wu recorded the illness in careful detail. The old woman’s arm was not the only problem: her tongue was also retracted — not a thick coating, but the tongue itself drawn inward and curled up, no longer a flat blade; the tongue would not move, and she could not get a word out. A layer of white coating covered the tongue. And worse than all of this: she could not swallow even a drop of water — every sip made her choke.

💬 Note from Doctor Luo: When the swallowing function fails today, the patient gets a stomach tube and liquid food pumped straight in — that gives you an idea how dangerous this illness was. This is a classic stroke. Doctor Wu analyzed it and fixed the nature of the disease: wind-stroke with phlegm, an excess pattern — the root lay in “excess,” in phlegm blocking the interior. Stroke can be deficiency, excess, or a mixture of both; you have to pull it apart and look at it piece by piece.

The previous doctor’s mistake: mistaking it for deficiency, piling on prepared rehmannia, until “all the tunnels were blocked”

This was not the old woman’s first visit to a physician. The earlier doctor saw a stroke and jumped to conclusions: a stroke must be deficiency — so he prescribed shu di (prepared rehmannia) and similar rich, cloying tonics.

💬 Note from Doctor Luo: And what happened? “All the tunnels were blocked” — the channels and collaterals were completely jammed. The tonic went in, the body could not absorb it, and the nourishment piled up inside the “tunnels” of the channels, blocking them worse and worse and actually aggravating the illness. This is where Chinese medicine shows its deepest craft: disease has deficiency and excess, and when the two are mixed, which is greater and which is less — should you unblock or tonify, do both, or mainly unblock? That “gauging” is the true skill of Chinese medicine. The previous doctor saw only the deficient side and not the blocked side; one dose of cloying tonic, and it was ruined.

Doctor Wu’s first move: open the lung first — the mystery of “the lung faces the hundred vessels”

Doctor Wu looked at the situation and did not rush to transform phlegm. He said three words first: “First, open the lung” — open up the lung qi.

💬 Note from Doctor Luo: Why open the lung? Chinese medicine says the lung governs the qi of the whole body, and also the lung faces the hundred vessels (fei chao bai mai). That “face” (chao) actually means “tide” — the lung, like a tide, rhythmically pushes the qi of the channels through the body. Let me say a little more here: at the Institute of Acupuncture of the China Academy of Chinese Medical Sciences, there is a researcher who studies what the channels actually are. He found that a school of Western medicine in Northern Europe holds that interstitial fluid circulates in the body — ordinary Western medicine says interstitial fluid does not flow, but this school says it moves like an underground current, passing through the fascia and the organs, nourishing and protecting the body. This researcher injected isotopes into animals and tracked them, and found that the interstitial fluid finally flows toward the lung — it is the lung’s breathing that pushes it along. So the body has two circulatory systems: the heart pushes the blood, and the lung pushes the interstitial fluid (the qi of the channels). The heart is the monarch official, the lung is the prime-minister official — the two systems exchange and support each other. This also explains why so many acupoints are named after water — for example, Yong Quan (KI1, “Gushing Spring”) on the sole of the foot. So one important way to regulate the body and its qi movement is to open the lung qi: once the lung qi opens, the movement of the channels returns to normal. Doctor Wu seized on this vital point from the very start.

Breaking down the formula: raw gypsum leads, one steady push to clear phlegm-heat and open the water passages

Once the direction was clear, the formula appeared. The herbs Doctor Wu prescribed look simple, but each one links to the next:

Sheng shi gao (raw gypsum) — clears heat from the lung and stomach; xing ren (apricot kernel) — descends and opens the lung qi; fresh sang zhi (mulberry twig) — unblocks the channels and expels wind; yun fu ling (Yunnan poria) — drains dampness; fang ji (tetrandra root) — promotes urination; bai tong cao (rice-paper plant stem) — frees urination and drains heat out through the urine; ban xia (pinellia tuber) — dries dampness and transforms phlegm; guang pi (Guangdong tangerine peel) — regulates the lung qi and transforms phlegm. Boil into three cups and take in three doses.

💬 Note from Doctor Luo: Look at this — fu ling, ban xia, chen pi: isn’t that Er Chen Tang (Two Aged [Ingredients] Decoction) (minus one herb, gan cao, licorice)? What does Er Chen Tang do? It transforms phlegm. So the logic of this formula is clear: xing ren and chen pi open the lung qi; shi gao clears phlegm-heat; fu ling, ban xia and tong cao drain dampness and transform phlegm; sang zhi unblocks the channels; fang ji and tong cao promote urination — one steady push to dissolve and expel whatever is clogging the channels. Someone may ask: isn’t raw gypsum for externally contracted diseases? Not at all — when there is phlegm-heat in the body and the heat signs are obvious, Doctor Wu routinely used raw gypsum for strokes with heat. The case record does not fully preserve the pulse, but Doctor Wu judged the heat to be very strong — my guess is that this old woman’s eyes were shot through with red, her face flushed like a drinker’s, and her pulse was full, forceful and strong. He also had this experience: contraction of the left limbs is usually viewed from the blood aspect (lower burner); paralysis of the right side is usually viewed from the qi aspect (middle burner). And heat can be cleared in many ways — if there is yangming bowel excess with constipation, you must also purge the bowels; that is another route entirely. As for the white tongue coating, I suspect it was photographed at the onset of the illness — if it drags on, the white coating turns dry and yellow, and in severe cases burnt yellow or black; I have seen tongues that were burnt yellow verging on black.

💬 Note from Doctor Luo: Let me add one more word about sang zhi (mulberry twig) — it is excellent at unblocking the channels. In my own practice I often pair sang zhi with si gua luo (loofah sponge): sang zhi is stronger at opening the channels (jing), si gua luo is stronger at opening the collaterals (luo); they divide the work slightly. I learned this from the late Professor Zhao Shaoqin of Beijing University of Chinese Medicine: in chronic nephritis, when patients complain of a sore, aching lower back, ordinary doctors treat it as kidney deficiency and tonify; Professor Zhao said that is really not it — most often it is damp-heat and blood stasis lodged in the lumbar region. Open it up with sang zhi and si gua luo and the backache clears at once, usually within a single dose. Sang zhi is a gentle herb, yet its unblocking power is very strong, and it also drains dampness.

One dose and she could swallow; in seven days the tongue swelling vanished — but the arm was still curled

The medicine worked with remarkable speed: after one dose she could swallow water again — no more choking; after seven days the swelling of the tongue was gone — she could stick her tongue out.

💬 Note from Doctor Luo: So the tongue had actually been a little swollen and curled inward — phlegm blocked it, fluids were excessive, and the tongue had swollen up. Once the medicine went in, the urine came out, the heat cleared, and the channels opened a little — the tongue swelling subsided.

But after twenty days, though the illness had gradually loosened, the effect had not reached the root: the left arm was still curled up exactly as before, the speech was still unclear, and the pulse beat unevenly — a knotted and intermittent pulse (mai jie dai).

Acupuncture was essential: one needle at Zhongquan beneath the tongue, and out came a “noodle”

Doctor Wu pondered for a long time, then understood: “There is stubborn phlegm blocking the collaterals — all the fault of erroneous tonification blocking the tunnels. It cannot be resolved without acupuncture.” The stubborn phlegm lodged in the channels could not be dissolved by herbal decoction alone; acupuncture was required.

💬 Note from Doctor Luo: This is one of Doctor Wu’s characteristics — he had a circle of friends who were superb acupuncturists, and he would say: “I write the prescriptions, but your needling is surely finer than mine — let’s work together.” Combining acupuncture and herbs was his normal way of practicing. So he called in his old friend — the master acupuncturist Mr. Jia Zhi Gu (transcription of the name).

Mr. Jia’s needling was superb. What did he do? He drove a needle into the Zhongquan point beneath the tongue — in those days a thick needle was used — and released a full half teacup of purple-black blood. The stranger part came next: something like an earthworm appeared at the needle hole, and Doctor Wu told the patient’s son to grab it with his hand and pull — out came a sticky, stubborn phlegm, like a noodle, fully seven or eight cun long (roughly 23 to 27 centimeters).

The lesson of draining the radiator: where the Ren and Du channels meet, a blockage must be released

After telling this breathless acupuncture story, Doctor Luo stopped to explain the “sublingual bloodletting” in plain terms.

💬 Note from Doctor Luo: It sounds hair-raising, but this is a real therapy — sublingual bloodletting (draining congestion from the veins under the tongue). Many Chinese medicine practitioners do it: some cut with a blade, some scratch with a needle-knife, and the stagnant blood comes out. People hostile to Chinese medicine once photographed it and posted it online, calling it quackery — that was unfair. I have asked many patients who have had their sublingual veins drained, and they say that the moment it is done the head feels suddenly clear — before, the brain felt like a pot of murky porridge, and in an instant it brightened up. And it is true that some people have a sticky, noodle-like substance pulled from the needle hole — some reddish, some jet black; that is real congestion. Why choose this spot? Chinese medicine holds that the Ren and Du channels (the Conception and Governing vessels) meet in the mouth, nose and tongue region, and this gateway is especially prone to blockage. Here is an analogy: in a northern Chinese winter, when the radiator is not heating — the floors above and below are warm but yours is cold — the repairman comes, opens the drain valve, lets out the dirty, rusty water, and the whole radiator heats up at once. Sublingual bloodletting works on the same principle: drain the blocked, dirty water, open the channels, and the person feels clear. But please, never try this at home — it must be performed by a professional.

After the sublingual needle, Mr. Jia also put one needle through Zhi Gou (SJ6) on the left hand, thrusting through the joint, and pricked San Yang Luo (SJ8) on the back of the hand with fine needles, more than ten in all, to open the channels completely.

Daily progress after the needles: walking with a cane after seventy doses, fully recovered in ninety days

After the acupuncture, the tide turned — from that day on, he made progress every single day.

💬 Note from Doctor Luo: Doctor Wu recorded it as “improving day by day.” The herbal decoction continued, but the gypsum was halved — from four liang (about 120 grams) down to two liang (about 60 grams), because the heat had mostly cleared by then.

After more than seventy doses (over two months), the old woman could walk with a cane; after ninety days (three months), she could leave the hall by herself and climb into a sedan chair to go out — every symptom was gone: the curled left arm and leg, the retracted tongue that could not speak, the choking on water — all cured.

💬 Note from Doctor Luo: By Wu Jutong’s standards this is a short case record. Many of his cases record the entire course of treatment, one formula per day, in extraordinary detail — beginning in the Qing dynasty, physicians kept ever more detailed records of cases, and that is a good thing.

A companion case: a 66-year-old man with a crooked mouth and a lifeless arm, fully cured in fourteen doses

After finishing this case, Doctor Luo added another of Doctor Wu’s cases of the same type, so the reader can see the whole approach.

💬 Note from Doctor Luo: Also an elderly man, 66 years old: mouth crooked, eyes askew, arm unable to lift, swollen legs, a full and surging pulse, thirst, no appetite — Doctor Wu diagnosed wind-stroke with dampness (zhong feng shi) and used the same pungent-cool method of opening the water passages: sheng shi gao, fu ling pi (poria peel), gui zhi (cassia twig), hua shi (talc), tong cao, wan can sha (silkworm droppings), ban xia and sang zhi, boiled into three cups and taken in three doses. Don’t you see how similar the approach is? The gypsum clears heat; ban xia and fu ling transform phlegm; sang zhi unblocks the channels; hua shi, tong cao and wan can sha drain dampness and clear heat; gui zhi warms and unblocks a little, so the formula does not become too cold. The result: effective in two doses, fully cured in fourteen! And afterward? Tonify the spleen and stomach, support the upright qi, consolidate the complete recovery — once the disease is cured, the spleen and stomach must be slowly built back up.

Doctor Luo’s closing words: reading case records is “evidence-based” — the pattern must match

With the case finished, Doctor Luo drew the thread back to the question of why we read ancient case records at all.

💬 Note from Doctor Luo: The ancients treated this illness, and it genuinely worked — that is the evidence. Reading ancient case records is evidence-based medicine in the strict sense: searching for evidence. But remember, not every stroke is treated this way. Some truly need tonification — we have discussed Bu Yang Huan Wu Tang (Yang-Supplementing, Five-Returning Decoction): large doses of huang qi (astragalus) to tonify qi, plus blood-invigorating, collateral-unblocking herbs. That is a completely different path. So when you meet a case record, match it dialectically: if the patient’s condition matches the ancients’ description, you can ask a qualified Chinese medicine practitioner to judge and try; if it does not match, do not force it. The value of Doctor Wu’s case here is that it adds one more pattern to our repertoire — the pungent-cool method of opening the water passages: opening the lung qi, unblocking the channels, promoting urination, clearing heat and transforming phlegm. Not every stroke is treated this way, but among stroke patients there is certainly this pattern of phlegm-heat blocking the orifices — and when you meet it, the ancients have already thought it through for you.

Compiled from Doctor Luo Dalun’s commentary on Doctor Wu Jutong’s case records; the case comes from the Wu Ju Tong Yi An (The Case Records of Doctor Wu Jutong) by Doctor Wu Jutong (Qing dynasty).