Diarrhea With Blood and a Rectum That Kept Falling Out?

Opening scene: it looks like dysentery, but it’s actually cold deficiency — don’t practice medicine by the textbook

💬 Note from Doctor Luo: I read this case when I was first studying medicine, and it left a deep impression — never practice medicine by the textbook! Every symptom of this patient looked like dysentery (an externally contracted intestinal infection), yet Doctor Li Dongyuan judged it a profound deficiency — qi deficiency attacked by cold. One formula, four herbs, with very light doses, and two servings cured it. That is what a master looks like.

Who was the patient? The first glance of inspection already said a lot

In the tenth month of winter in the guimao year, early winter, a light snow had fallen, and the cold was seasonable. An old servant in the household of Bai Shupan (an official title) fell ill.

💬 Note from Doctor Luo: Doctor Li began with inspection (look, listen, ask, feel — inspection comes first). One look at the old servant: his face was like dust, his color gone — gray and dull, as if covered in a layer of dust, his complexion abnormal. A normal East Asian complexion is “hidden red within yellow” — faintly rosy beneath the yellow. His face had none of that. His spirit was failing — deeply lacking in vitality, his body very weak.

What was the illness? Long-standing rectal prolapse — the anus protruding, even layers of the rectum dragging out. And the medicines had not worked — he had taken medication with no effect.

💬 Note from Doctor Luo: What does rectal prolapse tell you? The upright qi is insufficient and can no longer hold the organs in place. When the upright qi is strong, it keeps the organs inside the chest and abdominal cavity; when it is weak, qi runs downward and the organs are dragged out. The same category includes stomach prolapse and uterine prolapse in women — all things slipping out of place.

Recently it had worsened: he passed red-white discharge (dark stool tinged with red, sometimes with white pus), with tenesmus — the belly aching terribly, an urgent need to run to the toilet that couldn’t be held, yet little came out, and the belly still hurt afterward.

💬 Note from Doctor Luo: Remember the signature of tenesmus: belly pain → run to the toilet → pass little → still in pain afterward. Conventionally, tenesmus suggests infectious dysentery (external pathogen). And “more red than white” is normally read as heat. But Doctor Li did not read it that way.

Pattern analysis: look at the person first, then the weather, the clothes, and the blankets

Doctor Li began by analyzing what this man ate:

“This is not a person of meat and rich food; he must eat mostly vegetables. His diet is irregular. The cold comes in season, and his clothing and coverings are thin. Cold invades his body; cold transforms so that qi and blood can no longer hold firm — therefore things move downward and out.”

💬 Note from Doctor Luo: Doctor Li’s diagnostic approach is worth studying carefully — look at the person first:

• Occupation and status: an old servant — he doesn’t get to eat meat; his food is vegetables and coarse grains. (In ancient times, eating greens was not health food — it meant you couldn’t get anything good. Today we eat whole grains for wellness; back then sorghum and chaff were the worst diet. When I was a child, the folks in my hometown were sick of sorghum; city dwellers would trade their flour and rice ration coupons to bring white flour and rice back home. Now that we eat too much white rice, we go back to coarse grains — times change.)
• Irregular diet: working all day without enough to eat, then wolfing down a few mouthfuls — poor food, and the spleen-stomach gets damaged
• Thin clothing and coverings: a laborer’s conditions were poor — when it turned cold, he went on freezing

So: cold invades the body; his upright qi was already insufficient (the prolapse is the evidence), and once he caught cold, qi and blood could no longer hold firm — everything slipped downward.

There is an important principle here: when everyone stands in the same cold wind and only you get sick from the cold, there must be a problem inside — people with yang deficiency, qi deficiency, or heavy dampness catch cold more easily. Disease always arises from the combination of internal and external causes. Chinese medicine considers both together; you can’t look at only one side.

Treatment strategy: use sourness to stop the prolapse and check the slippage (mildly sour herbs to hold the qi and gather it upward); use strongly heating agents to expel cold and supplement yang; use qi-tonifying herbs to lift the yang and benefit the qi (push the qi upward).

The prescription: Hezi Pi San — four herbs, the qi and blood levels clearly separated

The formula is very simple, four herbs, centered on astringing and securing:

💬 Note from Doctor Luo: This formula deserves a careful walk-through:

Ying su ke (poppy husk) — yes, it really is the husk of the opium poppy; today it is a controlled substance and hard to obtain. It has an astringent, contracting action: it secures the lung (for chronic cough in the elderly), secures the large intestine (when diarrhea is severe), also secures the essence for kidney-deficiency seminal emission, and it stops pain. But it must not be used while a pathogen is present (external contraction or damp-heat) — only use it to astringe when the pathogen has been cleared and the upright qi can no longer hold. Chinese medicine uses the partial natures of medicines to treat disease — it is a controlled substance, yes, but it genuinely helps the body.

He zi (chebulic myrobalan) — similar to poppy husk: astringent and securing, enters the lung and large intestine channels, but without toxicity (it has another name, “Helile,” which sounds foreign — it has actually been used since very early times). It is used for chronic cough, and for long-standing diarrhea and dysentery of the large intestine; it also has a specialty: when a long cough has made the voice disappear, add he zi. Bloody stool, uterine bleeding, seminal emission, and vaginal discharge can all use it.

Poppy husk vs. he zi: one secures the qi (the monarch, chiefly preventing qi collapse), the other secures the blood (securing the blood level, treating the collapse of the form) — the qi level and the blood level, clearly separated! Even among astringents, Doctor Li separated them by qi and blood — that is refinement.

Pao gan jiang (blast-fried dried ginger) — expels cold and warms the spleen-stomach (he was too cold; warm him up). The dose is very light (6 fen).

Chen pi (tangerine peel) — here is the ingenious part! Conventionally you’d tonify qi with ginseng and bai zhu. Doctor Li used only a single herb, chen pi, to “benefit the true qi and generate yang.” Why? Dry the dampness and transform phlegm, letting the true yang restore itself — not pumping qi in directly, but helping you dissolve the dampness so the yang returns on its own. Doctor Li said, “tangerine peel is slightly bitter and warm; it benefits the true qi and generates yang to make it solid” — this is his personal insight into chen pi. Honestly, I have not yet reached this level myself — this is the realm of the gods: a single light touch of medicine and the disease dissolves.

How to take: grind into powder, divide into two servings (not two prescriptions — two separate doses). For each serving, decoct two cups of water down to one, drink it hot, dregs and all, ideally on an empty stomach.

The result: cured after two servings

Cured after two servings — two doses and he was well.

💬 Note from Doctor Luo: After the cure, Doctor Li probably gave a qi-lifting, yang-benefiting formula for aftercare, but the case record doesn’t say. Throughout this entire case, not a single herb was used to expel a pathogen — everything was astringing, warming the yang, and lifting the qi.

Bonus: treating illness is like solving a case — don’t be fooled by appearances

💬 Note from Doctor Luo: The greatest lessons of this case for me:

1. There are too many false appearances. According to the textbook, cold-induced diarrhea should be white; in reality, cold diarrhea with dark color is very common too. This looked entirely like dysentery (the “ate something bad” presentation), but the man was in winter, thinly dressed, deficient in upright qi, with pre-existing prolapse — clearly deficiency attacked by cold. If you treated it as dysentery and cleared damp-heat or resolved toxin, you would have treated him backwards and harmed him.

2. Gathering information is like detective work: the weather (in October, north and south differ), the age (a young man with strong yang catching cold differs from an old man), clothing, blankets, whether the air-conditioning was on, the diet (spicy hotpot or plain vegetables)… Internal and external causes together — only then can you find the real culprit.

3. Behind Doctor Li’s ease was deep care. He joked with Yuan Haowen while writing prescriptions (to soothe a terrified patient), but when it came to real cases he would go home and ponder — sometimes he didn’t write a prescription on the spot, but went home to think it through. Even a national master at that level was this careful — how much more should we be?

4. No divine physician sees through everything at a glance; no single formula fits everyone. Doctor Li’s formula was four herbs with light doses because his judgment was extraordinarily thorough — analyzing occupation, weather, clothes, and blankets step by step. That is the true attitude of treating illness.

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).