Top-of-Head Pain, Photophobia and Fainting Several Times a Day? Doctor Wu Jutong’s Case: Yin Deficiency and Liver Syncope Treated with Da Ding Feng Zhu
Patient’s search words: top-of-head pain / photophobia / fainting four or five times a day / postpartum arm pain / heat above, cold below Medical terms: liver syncope (hyperactive liver yang) · yin deficiency stirring wind · exhaustion of the fluids of the lesser yin channel (after postpartum misuse of warming, drying herbs)
Opening: a disease that looked like a “strange illness” — she could only settle in a pitch-black room
By the time of Doctor Wu Jutong, Qing-dynasty case records were kept in remarkable detail — which day, which herbs, what effect, written down day by day. The case we tell today is exactly such a day-by-day running account.
The patient was a 22-year-old young woman (Madam E E, a phonetic transcription of the name), not long after childbirth. How strange was her illness? Photophobia — so severe that if even a crack of light the size of a bean leaked through the curtain, she could not bear it and cried out; the room had to be made pitch black, with not a single glimmer, before she could settle down.
💬 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, author of Wen Tiao Bian (Systematic Differentiation of Warm Diseases). From the Qing dynasty on, doctors attached ever more importance to case records and wrote them in extraordinary detail — which is why, even today, we can still read such a complete account of a treatment.
Where the root of the illness lay: cold caught after childbirth, then “warmed” for a whole year
This illness was not contracted in a day. On New Year’s Eve (winter), she caught a little cold after giving birth — after delivery the blood and vessels are empty, and a new mother is most vulnerable to wind and cold — and so she developed pain in her arms and joints (bi tong). The doctor looked at it and thought: cold — the patient needs warming yang! So he prescribed warming, drying, hot herbs such as gui zhi (cassia twig) and fu zi (aconite root). And the result? The medicine worked wonderfully — “fu zhi da xiao” — it brought great effect.
💬 Note from Doctor Luo: The trouble was precisely that “it worked.” The doctor saw it work, concluded that this patient could never do without warming yang — and kept up the warming-drying herbs for more than a whole year! That is going too far. When the disease is cured, you stop — this is called zhong bing ji zhi, “stop the medicine as soon as the disease is resolved.” Day after day you light a fire with warming-drying herbs — who can endure that?
When Doctor Wu Jutong saw this, he uttered a famous saying: “Warming-drying and warming-nourishing are different — warming-drying can treat disease, but it cannot nourish life.”
💬 Note from Doctor Luo: These words are so important that they deserve to be unpacked. Tonifying yang (bu yang) and warming yang (wen yang) are not the same thing. Tonifying yang uses herbs like ba ji tian (morinda root) and tu si zi (dodder seed) — substances that gradually add the material basis of yang into the body; this can nourish life. Warming yang is like striking a match — herbs like gan jiang (dried ginger), gui zhi, rou gui (cinnamon bark) and fu zi make you hot in a hurry; they treat disease, but they must not be used every day. Here is an analogy: when you stew lamb soup, the lamb itself is the warming-nourishing substance — it is the material basis. The rou gui, gan jiang, hua jiao (Sichuan pepper) and spices are the “match-striking ingredients” that make it hot. The pot needs lamb for the fire to mean anything; if the pot holds only clear water and you throw in nothing but pepper, spices and dried ginger, the moment the fire stops the soup turns cold again — and it is undrinkable anyway.
The yin burned dry: top-of-head pain, photophobia, fainting four or five times a day
After more than a year of warming-drying herbs, what happened? The fluids of the lesser yin channel were seized and exhausted without remainder — the kidney-yin, the “material basis,” had been burned dry. When yin is deficient, the liver suffers first (the liver’s substance is yin, its function is yang — gan ti yin er yong yang): liver yang rises recklessly and deficiency fire rushes upward, producing three great symptoms:
First, top-of-head pain. Chinese medicine divides headache by location: the forehead belongs to the yangming channel, both sides to the shaoyang, the back of the head to the taiyang, and the vertex — the very crown of the head — to the jueyin. With liver-yin insufficient and liver-fire rushing upward, the pain sits at the crown of the head — the single point at the very top — unbearable pain.
Second, photophobia. When yin is depleted to the extreme, even a tiny bit of anything “yang” — and light is yang — becomes unbearable.
💬 Note from Doctor Luo: This symptom has a tradition behind it. Qian Yi, the founding father of Song-dynasty pediatrics, created Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) — originally prescribed for children — for liver-kidney yin deficiency. Such children are photophobic (wei guang xiu ming): the moment they see light, their eyes cannot open. Why? Yin deficiency — yin and yang no longer match each other, and even a sliver of sunlight is more than they can accept. This lady was an extreme case: any light at all made her cry out; the room had to be completely dark.
Third, fainting four or five times a day. From time to time she would “crash” to the ground and pass out — this is called jue (syncope). Four or five times a day — her consciousness was already affected, a genuinely dangerous state.
Doctor Wu felt her pulse: wiry, thready and rapid, without force on deep pressure — as fine as a lute string, beating very fast, but with no strength when pressed. It looked alarming, but in fact it was a deficiency pattern, at the height of danger. What to do? “Mian qiang yu yu yin xi feng” — do everything possible to nourish yin and settle wind: submerge the yang and nourish yin, so as to settle the liver-wind.
The prescription: Da Ding Feng Zhu — the classic formula for nourishing yin and subduing yang
What Doctor Wu used was Da Ding Feng Zhu (Great Wind-Settling Pearl) from the Wen Tiao Bian — the representative nourishing-yin formula of the school.
💬 Note from Doctor Luo: First let me mention its little brother, Xiao Ding Feng Zhu (Lesser Wind-Settling Pearl): ji zi huang (egg yolk), true e jiao (donkey-hide gelatin), sheng gui ban (raw turtle plastron), tong bian (the urine of a young boy), and dan cai (mussels). Dan cai is today’s hai hong (blue mussels) — cheap now, but in ancient times a nourishing delicacy valued almost as highly as sea cucumber (Doctor Luo corrected his own slip of the tongue: dan cai is not abalone). Da Ding Feng Zhu is indicated when pathogenic heat has lingered long, the true yin is exhausted, and the patient shows spirit fatigue with convulsive twitching (shen juan chi zong), a crimson tongue (she jiang), scanty coating, and the feeling of imminent collapse (shi shi yu tuo) — exactly this patient’s state of extreme yin exhaustion.
How is Da Ding Feng Zhu composed? Da Sheng Di, eight qian (raw rehmannia — cools the blood and nourishes yin; simmered long it also takes on some of prepared rehmannia’s kidney-tonifying nature), huo ma ren (hemp seed) (moistens dryness — when yin is insufficient the body turns dry inside, and it also helps move the bowels), sheng bai shao (raw white peony) (nourishes and gathers yin, softens the liver; it also relieves spasm and eases pain — cramping belly pain is also its business), sheng gui ban (raw turtle plastron) (nourishes yin and subdues yang), mai dong (ophiopogon) (replenishes fluids), e jiao (donkey-hide gelatin) (nourishes yin and blood), sheng bie jia (raw turtle shell) (nourishes yin and subdues yang; it also transforms stasis and clears steaming-bone tidal fever), hai shen, two strips (sea cucumber) (tonifies kidney essence), sheng mu li (raw oyster shell) (gathers yin and subdues yang, settles fright and calms the spirit — just right for a patient whose consciousness was already disturbed), zhi gan cao (honey-fried licorice), and finally two egg yolks.
💬 Note from Doctor Luo: How is the egg yolk used? This is Doctor Zhang Zhongjing’s method: after the decoction is finished and strained, drop the egg yolks into the hot liquid, stir them in, and drink. One great feature of Doctor Wu Jutong’s prescribing: he loved animal remedies — sea cucumber, mussels, abalone — these “flesh-and-blood, feeling substances” (xue rou you qing zhi pin). Abalone nourishes yin and carries a touch of yang-tonifying action besides — especially effective when heat rushes upward; the shell of the abalone is shi jue ming (abalone shell), heavy and subduing of yang. Sea cucumber tonifies kidney essence; egg yolk tonifies essence and nourishes yin — tonify essence and nourish yin together, and the effect is even better.
The day-by-day record: seven days of treatment, with ups and downs
What makes this case record so fine is that it was written day by day. On the first day of the first lunar month she took the medicine and showed a small effect; one liang of sliced abalone was added to the pot. On the second day the effect continued. On the third day: the fainting stopped (no more collapse), the headache greatly lessened — but she still feared light. On the fourth day, something new appeared — heat above the waist, ice cold below the waist, the body split into two halves; sweating on the left half of the body, no sweat on the right half — the two sides also split in two!
💬 Note from Doctor Luo: Doctor Wu said: “No ancient case record has ever seen this pattern” (zi gu fang shu wei jian ci zheng)! He quoted the ancients: “When qin and se are out of tune, one must change the strings and retune” — so he adjusted: he halved the dose of Da Ding Feng Zhu and added qing hao (sweet wormwood) (enters the liver and gallbladder, harmonizes them, and lets the pathogenic qi of the liver and gallbladder seep outward). That very night the fainting returned two or three times — she collapsed again!
On the fifth day: quickly restore the original full dose of Da Ding Feng Zhu. One dose, and the fainting ceased and the mind settled. It turned out that after qing hao had drawn the pathogenic qi outward, the formula’s nourishing-yin power still had to be restored to full strength. On the seventh and eighth days, still on the same formula, she gradually stopped fearing the light. On the twentieth day of the first lunar month, the curtains in the room were all taken down — light was no longer a problem. She continued the decoction until the second month, then, after the spring equinox, switched to Doctor Wu’s great tonic Zhuan Xi Da Sheng Gao (Special Great-Enrichment Paste) (a rich paste of various flesh-and-blood substances — to be explained in detail another day), and made a complete recovery.
Why did it look like a “strange disease”? — Yin could no longer hold yang, and deficiency heat rushed upward
💬 Note from Doctor Luo: The illness looked bizarre, but the principle behind it is quite plain. In the human body, yin and yang should each hold half, embracing each other. Yin is the material basis (blood, fluids, essence); yang is the warming, functional activity. Yin deficiency generates internal heat — like a car engine with no oil and no coolant: the moment it runs it overheats; yang deficiency generates cold. Suppose yin is one hundred and yang is one hundred — all is well; but when yin has been burned down to twenty while yang remains one hundred, the extra eighty has nowhere to go and bursts outward in a rush — and these eighty parts of deficiency heat rush upward, producing top-of-head pain, fainting, and the inability to bear light. This is yin failing to submerge yang (yin bu qian yang). That is why Doctor Wu did both: nourished yin (sheng di, bai shao, mai dong, e jiao) and subdued yang (gui ban, mu li, bie jia), pulling the yang back down — and the disease was cured.
Some doctors spend their whole lives talking about yang deficiency and never about yin deficiency. That is wrong. Doctor Luo once told a true story: he treated a patient with a blood disease along the nourishing-yin path, and the patient improved very well; later the patient went to Beijing to see a famous doctor, who added warming-yang herbs to the prescription — just that little bit of warming yang mixed in, and the patient’s condition plunged downward, straight to the point of emergency rescue.
💬 Note from Doctor Luo: With some diseases, the direction cannot be off by a single hair. A yin-deficient person can be undone by the slightest warming-yang herb — this is no joke. Why does yin become deficient? Staying up late, eating spicy food, thoughtlessly taking hot-natured medicines — all of these consume yin. Take this new mother in our case: after childbirth she was already short of yin blood — the pot did not even hold water — yet the doctor kept building the fire, for more than a year. However strong her constitution, in the end it could not hold out.
Bonus: how should a yin-deficient person nourish yin? — the old habit of “pouring boiling water over a raw egg”
💬 Note from Doctor Luo: Many long-lived old people once kept a habit: the family raised chickens, and every morning they would take a fresh egg from the coop, pour boiling water over it, stir, and drink it — “chong ji dan hua,” the whipped-egg drink. First, it made up the nutrition of the day; second, it genuinely nourishes yin and tonifies essence — many elderly people drank it and grew stronger, even their skin improved. This is the same principle. Likewise, Zhi Gan Cao Tang (Honey-Fried Licorice Decoction) treats palpitations from heart-yin insufficiency, and it includes huo ma ren (hemp seed) — not merely to move the bowels but to nourish the heart and moisten dryness. In Doctor Zhu Danxi’s time, nourishing yin mainly meant nourishing blood plus clearing heat; by Doctor Wu Jutong’s era, nourishing yin had basically come to mean replenishing fluids first, with blood-nourishing alongside — sheng di, bai shao, gui ban, mai dong, e jiao, bie jia, mu li: all of this family. The test is simple: a crimson-red tongue with a very thin coating usually means the person needs yin nourishment. Many elderly people today have all sorts of chronic imbalances, and adjusting them with this Da Ding Feng Zhu line of thinking works very well.
So the disease looked strange — but once the direction was right and the diagnosis accurate, step by step, the body was brought back into balance.
Arranged from Doctor Luo Dalun’s narration of the case records of Doctor Wu Jutong. The original case is from Wu Ju Tong Yi An (The Case Records of Doctor Wu Jutong, Qing dynasty).