Too Exhausted to Get Out of Bed, Diarrhea That Won’t Stop, No Appetite? Doctor Luo Tianyi’s Shengyang Tiaozhong Tang (Yang-Raising Middle-Regulating Decoction)

Opening scene: Doctor Li Dongyuan left few cases — read Doctor Luo Tianyi’s

💬 Note from Doctor Luo: Doctor Li Dongyuan left behind only a handful of cases. If you want to understand the scholarly thought of the master and the disciple, read Doctor Luo Tianyi’s cases instead — his living conditions were far better than Doctor Li Dongyuan’s wanderings and hardships, so the cases he left us are relatively complete.

This patient was a man of the very highest rank: Shi Gong, the Left Prime Minister of the Zhongshu Secretariat (67 years old).

💬 Note from Doctor Luo: Doctor Luo Tianyi was an imperial physician of the Academy of Medicine, and most of his patients were officials. In those days medical records wrote out the patient’s rank and full name (today we omit such details out of respect for privacy) — and that very practice is what lets us look up the historical records of this prime minister.

Onset and mistreatment: internal-injury diarrhea, sweated as if it were an external cold

In the ninth lunar month of the dingmao year of the Zhiyuan reign era, Prime Minister Shi fell into diarrhea from internal injury (exactly how his spleen-stomach was hurt is not recorded in detail — unclean food is the usual guess). After the diarrhea, he felt heavy and weary in his limbs (the spleen governs the four limbs — when the spleen-stomach is injured, the limbs lose their strength), had no appetite, loved lying down and spoke little (qi deficiency), his tongue could not taste flavors (when spleen qi is deficient, the sense of taste fades), and suffered abdominal pain, headache and nausea.

💬 Note from Doctor Luo: Headaches are distinguished by location — pain in the forehead connects to the Yangming stomach channel (so it is tied to the stomach), pain at the sides to Shaoyang, pain at the back to Taiyang, and pain at the crown to Jueyin. This gentleman’s headache was probably most obvious in the forehead, which points to the spleen and stomach.

A physician was called, and he took it for an external contraction (fear of wind and cold, headache — very much like a common cold). He gave Tongsheng San (a formula of the Fangfeng Tongsheng family, which induces sweating and purges downward) to induce sweating, even covered the patient in thick clothing — and out came great gushing sweat.

The result: the original symptoms were not relieved — they grew worse! Several more physicians were called; after more than four months of treatment, no one could cure him.

💬 Note from Doctor Luo: Doctor Li Dongyuan’s great contribution was to clearly separate external contraction from internal injury — the same symptoms (fear of cold, headache) can mean either an external pathogen or an injured spleen-stomach. He wrote an entire book, the Pi Wei Lun (Treatise on the Spleen and Stomach), to sort this out. Only after Doctor Li Dongyuan were external contraction and internal injury clearly distinguished. That physician evidently had not studied his lesson well: he treated internal injury as external contraction and sweated it, the sweat robbed the fluids, and the more he treated, the worse it got.

Doctor Luo Tianyi’s diagnosis: middle qi out of tune, rising and falling broken

At wit’s end, they summoned Doctor Luo Tianyi to Yanjing (today’s Beijing). He took the pulse: all six pulses were deep, fine and faint — an insufficiency pulse (an external contraction should present a floating pulse; this man had none).

💬 Note from Doctor Luo: The chief complaints were not wanting to eat and vomiting as soon as one ate — the spleen-stomach was severely deficient. Doctor Luo Tianyi’s diagnosis: middle qi out of tune — the spleen-stomach was weak; by nature the spleen qi rises and the stomach qi descends, but now the whole rising-and-falling machinery had failed.

Symptom analysis:

• Dry mouth and tongue — the spleen-stomach could no longer rise and fall, so fluids could not be carried upward
• Dizziness and blurred vision — insufficient upright qi; people with qi deficiency feel woozy all day (just the other day I wrote that people with qi deficiency are having a particularly hard time this summer — the spring lasted unusually long, and the rising-and-unfurling process consumed upright qi, so many people feel dizzy all day, and a short nap doesn’t restore them at all)
• Tired, sluggish limbs — spleen deficiency
• Cold calves — upright qi cannot be distributed to the four limbs, and cold pathogen has injured the yang qi (this gentleman had indeed been hurt by cold)
• Not wanting to rise from bed — insufficient upright qi, insufficient yang qi — the pattern of spleen-kidney yang deficiency (an important sign of kidney-yang deficiency: always wanting to sleep during the day)

The key clue — “he never drank alcohol, and his body was originally thin”: Doctor Luo Tianyi made a point of recording this sentence. For someone who drinks regularly, you must consider damp-heat; but this man did not drink and was thin and spare of build (unlike most Mongols — he was Han Chinese), so the likelihood that his yang had been damaged, that he had been hurt by cold pathogen, was high. All of this is diagnostic information!

The tongue was probably pale white, enlarged, with teeth marks along the edges, a white coating covering the surface, and saliva on top — though it was not recorded at the time, because tongue diagnosis was not yet developed in the Jin-Yuan period. Only in the Ming dynasty did Doctor Xue Lizhai, head of the Academy of Medicine, find a book on tongue diagnosis in the imperial library, retranslate it, and tongue diagnosis spread across the world. In Doctor Luo Tianyi’s era, diagnosis relied mainly on the pulse and symptom analysis.

The pathomechanism: his upright qi was originally insufficient (a thin man), then internal-injury diarrhea struck, and then mistreatment with sweating robbed his fluids heavily — the spleen-stomach grew ever more deficient, could no longer nourish the hundred channels and vessels of the body, and with no nourishment reaching anywhere, all these symptoms appeared.

The prescription: Shengyang Tiaozhong Tang — huang qi and ren shen as sovereign, tonifying the spleen as the core

Doctor Luo Tianyi’s summary: tonifying the spleen is the core — this is Doctor Li Dongyuan’s spleen-tonifying thought applied at the bedside.

He cited the Neijing: “When the spleen desires relaxation, urgently eat sweet flavors to relax it” and “When the spleen is deficient, supplement it with sweet flavors” — spleen-stomach deficiency must be supplemented with sweet flavors.

Usage: ground into a powder; one liang (about 30 g) of the powder was decocted and drunk.

The result: after drinking it, the vomiting stopped at once and his appetite visibly improved; three days later all the previous symptoms were gone — when the formula matches the pattern, it works quickly.

Aftercare: constipation must not be treated with purgatives — Mi Jian Dao (honey enema suppository)

The attendants around him said: “The previous symptoms are gone, but he has not had a bowel movement for nine days — may we give a little rhubarb purgative?”

Doctor Luo Tianyi said no: the Prime Minister is advanced in years with weak qi, and on top of that he has had diarrhea and profuse sweating, so his upright qi is even more insufficient; the yang qi of his spleen-stomach is severely damaged and can no longer transport fluids to the intestines — the intestines are dry. One must absolutely not use cold purgatives; they would injure the yang qi and the illness would become worse. This is exactly what Doctor Zhang Zhongjing taught: after profuse sweating, fluids are insufficient and the stool is difficult — one must not use Chengqi Tang (it would injure the upright qi).

💬 Note from Doctor Luo: So what to do? Use Mi Jian Dao (the honey enema suppository — Doctor Zhang Zhongjing’s method): fry honey in a pot until it turns thick and sticky, shape it while still viscous into suppository form, let it solidify, and insert it into the anus; it melts in the rectum and relieves the constipation. This is a method of last resort.

After it was used, more than twenty pieces of dry stool came out; the belly felt empty and comfortable, and the qi above and below moved in harmony.

Then Doctor Luo Tianyi had him continue drinking the previous medicine (Shengyang Tiaozhong Tang) slowly, and the Prime Minister’s appetite improved day by day until he began to enjoy food again.

Aftercare, part two: Jupi Zhizhu Wan — the secret of the lotus-leaf-wrapped rice

When an occasional slip in diet injured the spleen-stomach again, he was regulated with Jupi Zhizhu Wan (Tangerine Peel and Atractylodes Pill).

💬 Note from Doctor Luo: This is the famous family formula of Doctor Li Dongyuan’s household — it treats old and young alike with weakened original qi, food that will not digest, organs out of harmony, and stuffy oppression below the heart: bai zhu (atractylodes) two liang (about 60 g, stir-fried with bran) and tangerine peel (chen pi) one liang (about 30 g), ground into powder; wrap rice in lotus leaves and steam it, then mash the cooked rice into a paste and mix it with the medicine to form pills.

Here lies a secret: when Doctor Zhang Yuansu passed this formula to Doctor Li Dongyuan, he never said why the rice should be wrapped in lotus leaves. Doctor Li Dongyuan pondered it for a long time before he understood — the lotus leaf can lift the clear and send down the turbid, and it helps bai zhu raise the spleen’s qi! This formula is the master-disciple household treasure, passed down within the school.

The two formulas were used in turn, and after about a month of adjustment, the illness leveled out — his body returned to normal.

Ending: using medicine is like using punishment — guard your speech, moderate your diet

The Prime Minister was delighted: “Since the disease is cured, can I take some medicine to prevent it from coming back?”

Doctor Luo Tianyi said: There is no need for medicine! You only need to guard your speech (don’t talk too much, which drains your energy) and moderate your diet (in a high office there are many banquets — restrain what you eat). Then no medicine is needed.

💬 Note from Doctor Luo: Why? Because using medicine is like using punishment — the common people are punished only when they have committed crimes, and the organs need medicine only when they are diseased. When the body is not ill, it needs no medicine; taking medicine when you are well is like abusing punishment.

This is the thinking of the Li Dongyuan school — Doctor Li Dongyuan himself had such cases: a patient cured and asking for more medicine, and he would say stop once the severe disease is gone; don’t take medicine idly. It is the same for us today: don’t take medicine randomly. In most cases, whole grains, an optimistic mood, and active exercise will make the body better and better. Medicine is there to give the body a push when it is out of balance — never imagine taking it for half a year or a whole year (that is only for serious organic diseases such as tumors; ordinary imbalance is functional, and if you take medicine idly, one side may not have been adjusted before another has been over-adjusted).

As much as possible, regulate the body with food therapy, moxibustion, cupping, exercise, and adjusting your mindset — this is the thought of Doctor Li Dongyuan and his school: no abusing of medicine. When Doctor Luo Tianyi finished speaking, the Prime Minister “yue er ran zhi” — “what you say is excellent; I will do exactly as you say.”

Formula summary

Shengyang Tiaozhong Tang (Yang-Raising Middle-Regulating Decoction): specifically for internal-injury diarrhea — diarrhea after the spleen-stomach is injured, abdominal pain, weak limbs, no appetite, vomiting as soon as one eats, usually weak and wanting to lie down all the time, cold feet and calves, dizziness and blurred vision — a formula for spleen-stomach injury with a tendency toward yang deficiency. With huang qi and ren shen as the sovereign pair, plus dang gui and the other herbs.

Case source: Wei Sheng Bao Jian (Precious Mirror of Health) by Doctor Luo Tianyi; commentary based on public lectures by Doctor Luo Dalun (PhD in TCM diagnostics, Beijing University of Chinese Medicine).