Heavy Uterine Bleeding, Bloody Diarrhea, and a Body That Wouldn’t Stop Leaking?

Opening scene: watch a master work — almost like magic

💬 Note from Doctor Luo: What was it like when Doctor Li Dongyuan (李东垣) treated patients? Elegant and effortless — the prescription goes out, and the result is astonishing. Here is an example: the steward of Marquis Xuan De’s household invited him to treat a woman with unstoppable uterine bleeding. Every other doctor had failed. Doctor Li felt her pulse, asked for paper, and wrote down her symptoms — more than forty of them, one by one. The next day he came back and crossed them off one by one — 24 symptoms cleared in a single day. Within five or six days, the illness was completely gone. The marquis’s steward was stunned — he thought he was watching a divine being.

The famous poet Yuan Haowen recorded the same experience when Doctor Li treated him: he would announce in advance, “You should now be having these three reactions,” “Has this symptom cleared up yet?” — and he was always right. Yuan Haowen felt he was in the presence of a god. Why? Because Doctor Li understood human physiology and pathology with extraordinary depth. This is the level of a true national master of medicine.

A word on Doctor Li’s lineage: his teacher Zhang Yuansu worked entirely from the Huangdi Neijing (Yellow Emperor’s Inner Canon) — everything had to trace back to the Canon. And Qian Yi of the Song dynasty (the founder of Liuwei Dihuang Wan, the Six-Ingredient Rehmannia Pill) had a huge influence on them with his five-organ pattern diagnosis. Zhang Yuansu added his own innovations, and by the time the tradition reached Li Dongyuan it was essentially complete. In his own day people called him “Guoyi” — the National Physician, ranked first among all doctors. That was not an exaggeration.

Who was the patient? A complex illness dragged on far too long

Today’s patient was a woman whose illness was complicated and long-lasting:

• Menstrual blood black and clotted — very dark periods, congealed into clots
• A lump below the left ribs
• Watery diarrhea that would not stop — sometimes with undigested food visible in the stool
• Blood in the stool — clots of blood came out with the diarrhea, mixed into the water
• Chronically irregular periods, with diarrhea two or three times a day
• Discomfort and irritability after every meal, loss of appetite, growing thinner and thinner

💬 Note from Doctor Luo: Look at how complicated this is — blood pouring out of the front passage (menstruation) and the back passage (the bowels) at the same time, with diarrhea and wasting on top. How did Doctor Li read it? The visible blood of both the front and rear passages is collapsing downward — the blood is escaping downward and the body can no longer hold it.

Pattern analysis: this is not a simple “stop the bleeding” case — it’s a question of the whole body’s arrangement

Before explaining his prescription, Doctor Li opened with a long passage from the Huangdi Neijing:

“In treating any illness you must base yourself on the four seasons’ principles of rising, descending, floating, and sinking; on what is appropriate to change with the times; you must first consider the qi of the year and not harm the harmony of heaven. Do not strengthen what is already excessive, do not weaken what is already deficient, and leave the patient to an untimely death; do not summon evil and do not lose the upright, cutting off a long life.”

💬 Note from Doctor Luo: This passage is the very heart of the Li Dongyuan school! What does it mean? The qi movement of the human body corresponds to the four seasons:

• Spring → the liver, qi rises (growth)
• Summer → the heart, qi floats (full flourishing)
• Autumn → the lungs, qi descends (gathering)
• Winter → the kidneys, qi sinks (storing)

Doctor Li and Zhang Yuansu matched this system to medicinal herbs — every herb has a “drug image” (yao xiang): which season does it belong to, does it help qi rise or descend? This is the theory of drug images. You first look at what “arrangement” your body is currently in, then use herbs to guide it back to the correct arrangement.

Doctor Li then quoted Zhang Zhongjing: “When yang is excessive and yin deficient, purging cures and sweating kills; when yin is excessive and yang deficient, sweating cures and purging kills.” Sweating and purging must never be used carelessly — you have to read the yin-yang arrangement of the body first.

So what arrangement was this woman in? Doctor Li analyzed:

• Unstoppable menstrual leakage (blood escaping from the front passage) plus years of watery diarrhea (qi and blood collapsing from the rear passage) — the whole body’s qi and blood are running on the “autumn-winter program” (sinking, scattering, storing). This is the autumn-winter arrangement!
• Why can’t she enter the spring-summer program (yang giving birth, yin growing)? Because the spleen qi (stomach qi) cannot ascend — the spleen is not lifting the clear upward, so there is no rising power in the qi mechanism.
• When the spleen and stomach are sick, the whole body’s qi and blood cannot grow: the muscles shrink and the appetite fails — the two vital energies are nearly exhausted. This is a serious illness.
• After dragging on this long, even if there was some heat at the start, now the lower burner is yang-deficient and heavily invaded by cold-dampness.

Treatment strategy: drain cold with heat (warm the yang) + dry dampness with dryness (wind overcomes dampness — use wind-dispersing herbs to lift the dampness upward) + lift loudly and greatly to support growth (push the medicinal nature upward to return the body to the spring-summer program) + nourish qi and blood.

💬 Note from Doctor Luo: Do you see the shadow of Doctor Zhang Xichun here? Sheng ma and chai hu lifting the qi upward — the Shengxian Tang (Lift the Sunken Decoction) that Doctor Zhang Xichun used for qi sinking came straight from this idea! Doctor Li Dongyuan opened a gate that later generations walked through.

The prescription: Yiwei Shengyang Tang

The exact formula was Yiwei Shengyang Tang (Benefit the Stomach, Lift the Yang Decoction). (Some old books mistakenly record it as “Chaihu Tiaojing Tang” — that is wrong; the most accurate name is Yiwei Shengyang Tang.)

“When blood collapses, replenish qi — this is the method of the ancient sages.” The blood is escaping downward because the qi is too weak to hold it, so first supplement the stomach qi (spleen-stomach qi) to support the growing, generating energy.

💬 Note from Doctor Luo: The soul of this formula is the two wind herbs sheng ma and chai hu — they lift the qi of the liver, gallbladder, spleen, and stomach upward. This is precisely the thinking behind the later Buzhong Yiqi Tang (Tonify the Middle and Benefit Qi Decoction)! Doctor Li said that tonifying the spleen-stomach is tonifying the blood (when yang grows, yin grows along with it — only when yang is sufficient can yin be generated), which is why “blood collapse calls for replenishing qi” — when blood is escaping downward, supplement the qi first.

The raw scutellaria is a flexible addition: in hot summer weather, when the heat consumes the qi mechanism, add a little to clear heat and protect the lung metal; when autumn turns cool, remove it.

How to take it: grind it fine, take one to two qian at a time, boiled in water — the same frugal, economical style of medication that Doctor Li favored.

The outcome: not written down — but the method survived

💬 Note from Doctor Luo: This case record ends without recording the result — the moment the prescription was written, the record stops. Why? Because the story of the marquis’s steward at the beginning already told you: 24 symptoms cleared in one day, complete recovery in five or six days. The point of this case is not the outcome — it is the complete process of how Doctor Li thought about illness: his philosophy, his reading of the body’s arrangement, his reasoning. That is the truly precious part.

Bonus: why this is “one generation standing on the shoulders of giants”

💬 Note from Doctor Luo: Look at this — Doctor Li’s Yiwei Shengyang Tang, with astragalus leading and sheng ma and chai hu lifting — when it reached Doctor Zhang Xichun, his Shengxian Tang uses essentially the same approach, essentially the same herbs. Great masters always stand on the shoulders of the masters before them. This is how Chinese medicine has been passed down, generation after generation.

When I was studying at Beijing University of Chinese Medicine, I heard the elder Professor Ren Yingqiu say: as a young man studying medicine, he always heard that Zhang Yuansu had trained a master like Li Dongyuan using his own private textbook, and he desperately wanted to see that book. When he finally got hold of it, he treasured it like a priceless jewel and studied it for years. That is the attitude we students of Chinese medicine should have — these theories are enormously useful, and they may well help us improve our own clinical results.

Case source: Lan Shi Mi Cang (Secrets from the Orchid Chamber) by Doctor Li Dongyuan (compiled by his disciple Luo Tianyi); commentary based on public lectures by Doctor Luo Dalun (PhD in TCM diagnostics, Beijing University of Chinese Medicine).