Belly Swollen Like a Spider After Grief, Unable to Eat? Doctor Wu Jutong’s Case of Single Abdominal Distension (Dan Fu Zhang): Untie the Heart’s Knot First, Then the Medicine — Ten Doses Saved Her Life
Patient’s search words: belly swollen huge / belly bulging like a spider / can’t eat after overwhelming grief / bad mood / bloating Medical terms: single abdominal distension (dan fu zhang) · tympanites (gu zhang) · liver qi stagnation · qi stagnation with blood stasis (qi becomes blocked after a devastating emotional blow)
Opening: “gu zhang” — one of the four great terminal illnesses of ancient China — walks into the clinic today
We continue the stories of Doctor Wu Jutong, the great Qing-dynasty physician. This time the subject is again gu zhang — a swollen, distended belly.
💬 Note from Doctor Luo: Don’t underestimate those three words, “a swollen belly.” Ancient medicine spoke of four great terminal illnesses — “wind, consumption, drum, and blockage” (feng, lao, gu, ge). The “drum” (gu) is gu zhang: cirrhosis with ascites, kidney disease with edema — in all of these, the belly swells enormously. There was also an old saying: “men fear putting on boots, women fear wearing hats” — men fear the legs swelling first (as if wearing boots), women fear the upper body swelling first (as if wearing a hat), and in ancient times that was often a death sentence. Even today, some kinds of edema are not easy to treat; behind a seemingly mild swelling may lurk heart failure, kidney failure, or end-stage liver disease. So gu zhang was never a minor illness.
The patient who now walked into the consulting room was exactly such a case — Madam Guo, 62 years old. And her illness began with a devastating grief.
Who is the patient? Her husband died at an ancestral grave two hundred li away
Madam Guo’s life had been hard. Her husband went to tend the family’s ancestral grave two hundred li (about 60 miles) away, and there — for reasons unknown, most likely overwhelmed by sorrow — he suddenly died right in front of the grave.
💬 Note from Doctor Luo: Some people may wonder: how could a 62-year-old woman still have a small child? In the old days there was no contraception; women commonly had six or seven children, bearing from their teens into their forties or fifties. There really were historical jokes about “a grandmother and her daughter-in-law being pregnant at the same time” — people laughed at that as a joke, but it truly happened.
When the news of her husband’s death arrived, Madam Guo rushed the two hundred li with her young son to attend the funeral. At the graveside, her grief was beyond measure: hungry but unable to eat — she was starving, yet food repelled her; cold but unwilling to put on clothes — the weather turned cold, yet she didn’t care. After burying her husband, she built a small shed beside the grave and lived there for a full hundred days, sleeping on the ground, weeping without cease, eating almost nothing, wearing only thin clothes.
💬 Note from Doctor Luo: This custom of living beside the grave was called “lu mu bai ri — keeping vigil at the tomb for a hundred days.” Extreme grief, combined with cold, fasting, and sleeplessness, utterly broke her body. When a person cries and drains herself like this, the spleen and stomach collapse first.
When she finally came home, Madam Guo was ill — she had developed single abdominal distension (dan fu zhang).
How ill was she? A terminal illness meeting a death pulse
What is single abdominal distension? It is a form of gu zhang: the belly swells enormously, like a spider, while the arms and legs become pitifully thin. Inside such a belly there may be trapped qi (so it sounds hollow when tapped), or blood, phlegm, and stasis — phlegm, stasis, water, and blood tangled together in a very complex way. That is why single abdominal distension has always been terribly hard to treat.
💬 Note from Doctor Luo: Ordinary doctors flinch at the sight of single abdominal distension — arms and legs wasted, belly bulging like a spider. Everyone knows how hard that is.
When Doctor Wu Jutong arrived and took her pulse: all six positions showed no stomach qi — not a trace of life-force in the pulse. And looking at the woman herself: she panted continuously; she could not eat; her lips were scraped white — a ring of whiteness around the mouth, without a drop of blood color; her complexion was a dull yellow; her body was emaciated.
💬 Note from Doctor Luo: Lips scraped white show spleen-blood insufficiency and spleen deficiency; a dull yellow face is also spleen deficiency. The person is terribly thin while the belly swells enormously — and with no stomach qi in the pulse, there is no life-force. This illness truly was a terminal condition meeting a death pulse — the danger could not have been more extreme.
How did Doctor Wu Jutong think? Feelingless herbs cannot cure an illness born of feeling
But Doctor Wu Jutong’s way of practicing was different from everyone else’s. He knew clearly: the root of this illness was not in the belly — it was in the heart. This woman no longer had any will to live.
He said a classic sentence: “Wu qing cao mu, bu neng zhi you qing zhi bing” — feelingless herbs and trees cannot cure an illness of feeling.
💬 Note from Doctor Luo: Herbs are without feeling, and this illness was caused by emotion — her husband died suddenly, she grieved until all hope died within her. How could herb medicine alone treat that? So it was necessary to “kai qi yu meng” — first open the dead knot in her heart, “shi qi qing zhi chang sui” — let her emotions flow freely again. Only then could medicine have any hope of working, even by a slim chance.
This brings us to one of Doctor Wu Jutong’s special skills: “shuo bing” — talking the illness. Apart from writing brilliant prescriptions, his command of words was a marvel in itself.
💬 Note from Doctor Luo: Doctor Wu inherited this idea from Doctor Zhu Danxi — when you meet a patient, you must talk to them. The ancients spoke of “zhu you” (incantation healing), and people assume it means drawing talismans; Doctor Wu said that view is far too narrow. Zhu you also means “talking the illness through” — using verbal communication to shift the patient’s emotions. That too is part of zhu you. Doctor Wu’s understanding of zhu you went much deeper than most people’s.
And toward this Madam Guo, Doctor Wu Jutong felt a deep empathy — because when he was young, his own father died, and no physician could cure him. As a scholar, he built a shed beside his father’s grave and read medical books, vowing to learn medicine: “My father was ill, and I did not even know what disease he had — what face do I have left to stand under heaven and earth?” So he understood the pain of losing a beloved parent — and precisely because he understood, he knew how to counsel her.
The great counseling scene: you are not allowed to die — you are not allowed to be ill
Doctor Wu Jutong opened the conversation: Your grief, he said — it pierces your heart and head ten times harder than an ordinary person’s. Why?
Madam Guo answered through tears: my husband is dead and cannot come back; he left two children behind, and I fear they may never grow to adulthood.
Doctor Wu Jutong heard this and said: How can you be so confused? “Ru he bu ming zhi shen ye!” — How can you fail to see so clearly!
💬 Note from Doctor Luo: Doctor Wu began to reason with her, and this passage is a classic. He said: when a woman’s husband dies, she is called a “wei wang ren” — a person not yet dead, one who in her own heart is only waiting for death. If you truly miss your husband and really want to die, that is easy enough — die right now at the grave, and you can be buried with him immediately. But wait! You still have two sons!
When your husband was alive, you put him first — you helped your husband and taught your children. Now that he is gone, you should put the raising of your sons first — bringing the children up is precisely your husband’s unfinished work. The children have already lost the great tree that sheltered them from wind and rain; if you die too, who will raise them? What suffering will they endure at their tender age?
💬 Note from Doctor Luo: Doctor Wu continued: In this way you do your dead husband no good at all — he is gone — but you wound your sons severely. When you reach the Yellow Springs and meet your husband, he will ask: where are the children? What will you answer? How could he be pleased? So if you truly want to fulfill the way of a wife, you must understand your husband’s heart — he must be longing for you to raise those boys to adulthood.
So now you must not die — and you must not even fall ill. If you are sick, how will you teach the children? And if you want to avoid illness, you must open your heart and let it flow — get your emotions in order. Only then can this disease be cured.
💬 Note from Doctor Luo: Finally Doctor Wu laid out the medical truth: single abdominal distension is a terminal illness, and a pulse without stomach qi is a death pulse. A terminal illness meets a death pulse — what is to be done? Your heart-fire must blaze — your will to live must burn fiercely. Then drain the yin qi of the depressed liver — release the stagnant, yin-clogged qi of the liver, let the blood vessels flow freely, and the visceral qi can recover. That is how even a terminal illness finds a road back to life. This is what the Book of Songs means by “jian xian yue xiao” — when thick fog hangs over everything, the moment the sun appears, all the mist dissolves. If you understand this truth yourself, then I will treat you!
The turning point: one great laugh, and life-force returned
Madam Guo listened, stunned for a long while — then she thought: Heavens, that is the truth of it! I have been wallowing in my grief, wishing I could follow my husband — but what about these two children? Everything Doctor Wu said made sense.
She burst out laughing.
💬 Note from Doctor Luo: Doctor Wu Jutong said: laughing gives birth to sheng — life-force! Your laughter, right now, is life returning! From that day Madam Guo never wept again. Moreover, she dared not brood — she devoted herself wholly to joy: “My only wish is to raise my children well, so I must be happy!” Doctor Wu said: if you yourself want to live this much, you will live. And so he wrote the prescription.
Anatomy of the prescription: herb after herb, all for opening stagnation and regulating qi
What Doctor Wu Jutong prescribed was a formula to open depression and dissolve knots — built on the thinking of Xuan Fu Hua Tang (Inula Decoction).
💬 Note from Doctor Luo: The Xuan Fu Hua (inula flower) should be wrapped in xin jiang sha — newly dyed red silk while decocting. What is xin jiang sha? It is red cloth dyed with madder root (possibly dyed with rosewood instead), and it has the effect of activating the blood and stopping bleeding — it helps the inula flower regulate qi. Xuan Fu Hua Tang is simply Xuan Fu Hua + Xin Jiang + scallion white, a formula of Zhang Zhongjing for liver-channel blood stasis, qi stagnation with blood stasis — regulating qi and unblocking the collaterals. Whenever Doctor Wu Jutong treated serious emotional illness or liver-channel blood stasis, this was his favorite framework.
Now look at the full formula: Xiang Fu (cyperus) regulates qi, Guang Yu Jin (curcuma) regulates qi, Jiang Ban Xia (ginger-processed pinellia) descends qi and transforms phlegm, Qing Pi (green tangerine peel) breaks stagnation, Su Zi Shuang (perilla seed frost) descends qi, Jiang Xiang Mo (rosewood powder) regulates qi, Guang Chen Pi (tangerine peel) moves qi, Dang Gui Xu (angelica rootlets) nourishes the blood and unblocks the collaterals, Chuan Hou Po (magnolia bark) drains dampness and regulates qi — every single one regulates qi.
💬 Note from Doctor Luo: Here is a special touch unique to Doctor Wu Jutong: Su Zi Shuang. Perilla seeds used alone tend to cause loose stools (they moisten the intestines). Doctor Wu pressed the oil out of them to make a “frost,” so the herb can regulate and descend qi and open the lung qi — without the laxative effect. This formula is a classic approach whenever we face liver qi not moving smoothly, blood stasis from bad moods, stabbing pain in both flanks, or even liver wood overwhelming the spleen earth causing a bloated belly with qi stuck in the middle — Doctor Wu treated the liver collaterals like this constantly, with only small variations.
The result: a dozen or so doses, complete recovery
So the prescription was sent out — how did it work?
💬 Note from Doctor Luo: “Shi shu ji er shou quan gong” — in about ten doses the whole battle was won! A patient who seemed destined to die was completely cured. Let me tell you, this is extraordinarily hard to achieve. Patients with single abdominal distension are not turned around overnight.
Doctor Wu Jutong had untied the knot in her heart first — the woman herself chose to live — and then the medicine smoothed out the stagnant, knotted qi and blood. Mind and body were treated together, and the illness was cured.
💬 Note from Doctor Luo: To be frank, where was Madam Guo’s luck? Her luck was that the illness had come on quickly — grief, cold, stagnation, bitter weeping, all in one burst, so the root of the disease was not yet deep. If her spleen and stomach had been truly destroyed, or her liver channel had fallen into major disorder, or her kidneys were ruined, even Doctor Wu Jutong might not have saved her. But precisely because it was acute, the moment the heart’s knot loosened, the qi movement turned, and the illness followed.
Closing: treating body and mind together is the true art of healing
The most valuable thing about this case is not the formula — it is the order Doctor Wu Jutong followed: treat the heart first, then the body.
💬 Note from Doctor Luo: I keep saying “body-mind, body-mind” — the two must be adjusted together, or the illness will never truly be cured. If you only soothe the liver and regulate qi for a patient, and he goes home and gets angry again, and you soothe the liver again, and he gets angry again — you may prescribe for him your whole life, but is he really well? No. True healing should lead a person toward a happy life: first untie the knot in the heart, create a turning point in the thinking, and then if the body still has a small problem, adjust it lightly. This is what treating body and mind together means.
💬 Note from Doctor Luo: Our whole medical system today leans toward the material — it only adjusts the body and leaves the psychological side to psychiatrists, but how many patients actually go to a psychiatrist? So what often happens is: the patient comes back from treatment, not better, and anxious; the more anxious the treatment makes him, the worse the illness becomes. I later lectured on the Daodejing for a year and a half — why? Because I felt it from the bottom of my heart: if the emotions are not put in order, no amount of body-adjusting will quite do the job. The great physicians of old — Doctor Zhu Danxi, Doctor Wu Jutong — showed us exactly this style: the truly great physician is the one who treats body and mind together.
Madam Guo, at 62, was nearly killed by the grief of losing her husband. Doctor Wu Jutong’s words untied the knot in her heart; ten doses of medicine smoothed her qi and blood; and the “terminal illness” was brought back to life. The illness was in the belly; the root was in the heart — that is the most precious lesson the great physicians of the Qing dynasty left us.
Compiled from Doctor Luo Dalun’s commentary on the case records of Doctor Wu Jutong; the case is from Wu Ju Tong Yi An (《吴鞠通医案》 — The Case Records of Doctor Wu Jutong), Qing dynasty.