Morning Diarrhea, Gurgling Belly, and the Doctor Who Prescribed Hot Herbs in the Dog Days of Summer

Opening scene: it’s the hottest month of the year, and the imperial physician prescribes aconite and dried ginger

In the summer of the 26th year of the Zhiyuan reign of the Yuan dynasty (1289), the skies over Shangdu — the summer capital of the Mongol empire, near today’s Zhenglan Banner in Inner Mongolia — opened up into days of unbroken cold rain. By ordinary logic, in the middle of summer no doctor would dare reach for strongly heating herbs: with weather this hot, hot medicines are supposed to stay on the shelf.

But this time the imperial physician Doctor Luo Tianyi did exactly the opposite. In the sixth lunar month, at the height of summer, he gave his patient a formula built around gan jiang (dried ginger) and fu zi (aconite) as the leading herbs — the Fuzi Wenzhong Tang (Aconite Middle-Warming Decoction).

💬 Note from Doctor Luo: Chinese medicine has a saying: “when using heating herbs, keep your distance from summer” — in hot weather you normally minimize hot medicines. That’s the general rule. But in this case the patient genuinely had a cold pattern, cold right down to the bone, and that calls for special handling: treating illness should always follow the patient’s actual condition, never mechanically follow the season. When summer genuinely calls for heating herbs, you use them all the same.

Who was the patient: Counselor Shang, sixty-two, still carrying the weight of the court

The patient’s surname was Shang, and his office was Can Zheng — Counselor-in-Chief of the Zhongshu Secretariat, in practical terms a minister-level grandee of the Yuan court. That year he was sixty-two years old.

Doctor Luo Tianyi always opened his case records by naming the patient’s position and age, and there’s a reason for it. What defines a high official’s life? Worry. Constant worry easily unbalances the liver qi; constant toil wears the body down. Sixty-two today would be retirement age, but this man was still on the job — and not just on the job, but in a top post with crushing responsibilities. At that age the zheng qi (upright qi) is no longer at full strength, and he carried a pre-existing weakness: stomach deficiency, a constitutionally weak spleen and stomach.

💬 Note from Doctor Luo: See how Doctor Luo Tianyi works? Before anything else he points out the patient’s occupation and age. Official duties, worry, overwork, advanced years — string those facts together and the baseline of the body appears: insufficient upright qi, weak spleen and stomach. That baseline is the foundation for every analysis that follows.

How the illness began: days of cold rain falling on a weakened spleen and stomach

That summer Counselor Shang had followed the emperor to Shangdu to escape the heat. In the sixth lunar month (July by the solar calendar) — normally the hottest stretch of the year — the rains came down without stopping, day after day. Not a shower that passed, but an unbroken, relentless downpour.

Doctor Luo Tianyi makes a point of the wording: this was no ordinary drizzle, it was lin yu — continuous soaking rain. In such weather the whole environment turned wet and cold.

And at that very moment, two things Counselor Shang couldn’t avoid piled on:

• Overwork from official business — pressing tasks from above, exhausting duties;
• Irregular eating — at night the emperor feasted his ministers and he ate too much; at dawn he rose early for court without breakfast. Starving one moment, stuffed the next.

Overwork drains the upright qi, disordered eating injures the spleen and stomach, and on top of both came that wet, cold, unbroken rain — three factors stacked together, and the illness arrived.

How sick was he: every morning, a painful, gurgling dash to the toilet

Doctor Luo Tianyi remembered the symptoms precisely:

Every morning, pain first rose around the navel, the belly gurgled and rumbled, and then he had to rush to the toilet — one or two loose bowel movements — before things settled down a little.

Beyond the diarrhea, three symptoms drained his spirits:

• No appetite — he didn’t want to eat;
• Reluctant to speak — his voice had no strength, he didn’t feel like talking;
• Body heavy and tired — no strength anywhere, a languid, sluggish state.

💬 Note from Doctor Luo: Many of you will feel a shock of recognition at this list — no energy, not wanting to talk, exhausted, no appetite. Isn’t that exactly how a lot of us feel today? That’s what insufficient upright qi looks like. Plenty of people feel this way come summer. But Counselor Shang was a minister with duties he couldn’t put down, so he had to find a doctor — and he found Doctor Luo Tianyi, an imperial physician.

Doctor Luo Tianyi’s reasoning: when the upright qi is weak, cold-damp dares to bully the spleen

One touch of the pulse and Doctor Luo Tianyi understood the case. His analysis advanced layer by layer:

Layer one: the foundation was weak. Advanced age, weakened qi, a spleen and stomach with a long-standing deficiency-cold constitution — in his later years the yang qi of the spleen and stomach was simply running low.

Layer two: external factors stacked on top. The cold soaking rain, the overwork, the disordered eating — once, twice, three times the insults accumulated, and they broke down a body already fragile at its weak point. What do you call that? Illness born from deficiency — cong xu zhong lai.

Layer three: the classics confirm it. The Nanjing (Classic of Difficult Issues) says: “Improper diet and overwork injure the spleen.” Chaotic eating harms the spleen and stomach; overwork harms the upright qi and the spleen as well. It also says: “Where deficiency departs, excess follows.” Wherever the upright qi is insufficient, evil qi is sure to come in behind it — deficiency of upright qi and excess of evil qi always travel together.

Layer four: the five movements and six qi. Doctor Luo Tianyi also drew on the doctrine of yun qi (the annual cycles of the five movements and six qi). The Huangdi Neijing (Yellow Emperor’s Inner Classic) teaches: “If the year’s fire movement is insufficient, cold prevails on a grand scale.” In a year when the fire qi is weak and cold qi presses in, the cold is especially severe, and the people readily suffer wu tang — duck-dropping diarrhea, the classic loose stool of cold.

💬 Note from Doctor Luo: This is the five-movements-and-six-qi way of thinking — which qi governs the year, which qi presides over the heavens, which qi sits below, and what illnesses the people tend to get under that pattern. In fact, long before the recent pandemic, many Chinese medicine practitioners used the Neijing’s yun qi calculations to predict that such a year would see epidemics. And so it proved. This particular year the weather turned unusually cold; this patient’s spleen yang was already weak; add rain every day, and the cold-damp came to bully the spleen earth. The spleen earth couldn’t hold, so the diarrhea poured out.

Layer five: the five-element conquest cycle. The spleen and stomach’s upright qi was insufficient, water-damp ran rampant, yang qi was low — the cold-damp came to insult the spleen earth (water insulting earth), and the spleen earth collapsed. Doctor Luo Tianyi quotes the Neijing’s saying about evil attacking “what the body cannot defend, riding on what it can overcome”: evil qi goes after the organ it is able to restrain. In this state the disease was not a liver problem or a heart problem — without a strongly heating formula, one could neither drain the cold water nor restore the spleen earth.

The diagnostic highlight: summer calls for cooling herbs? — “When cold invades within, treat it with acrid and hot”

Conventional summer prescribing follows the rule “use heat, keep distance from summer” — minimize heating herbs. But Doctor Luo Tianyi said: this year is exceptional (insufficient fire movement, grand cold), and the patient’s condition truly matches — so for the moment, handle the case according to the patient’s actual present state.

The Neijing states it plainly: “When cold invades within, treat it with acrid and hot.” When cold evil attacks the interior of the body, you meet it with acrid-hot medicines.

So Doctor Luo Tianyi wrote out a warming formula — the Fuzi Wenzhong Tang (Aconite Middle-Warming Decoction) — with gan jiang and fu zi, acrid, sweet, strongly heating, as the monarch herbs, to drain the cold water and warm the yang qi.

💬 Note from Doctor Luo: You might think: this Chinese medicine business is too simple — see a cold pattern, prescribe dried ginger and aconite. Simple on the surface, yes. But if you want to go deeper, there’s a whole ocean of theory underneath — a complete system of prescribing created by the great teacher Zhang Yuansu (the Old Man of Jiegu, who taught Doctor Li Dongyuan), and the signature technique of this entire school.

Breaking down the formula: Zhang Yuansu’s “Images of Medicinal Use,” moving a patient from winter back to summer

Zhang Yuansu was a great physician of the Jin dynasty and the teacher of Doctor Li Dongyuan. He created a system called the “Images of Medicinal Use” (yong yao fa xiang): he divided medicines into several major categories corresponding to the four seasons plus long summer — five stages across the year. When treating a patient, he observed the rising and falling, warming and cooling of the qi of heaven and earth, then looked at which stage the patient’s body had pathologically drifted into — “which season the body had walked into” — and used the corresponding medicines to move him back to the correct season.

The five categories run like this:

① Wind rising and generating — matches spring. Herbs with thin flavor, yang within yin; thin flavor penetrates. Their action rises and generates, carrying the character of wind. Examples: fang feng (siler), sheng ma (bugbane root), qiang huo (notopterygium), du huo (angelica pubescens), chai hu (bupleurum), qian hu (peucedanum), ge gen (kudzu root), wei ling xian (clematis), xi xin (asarum), bai zhi (angelica dahurica), jie geng (platycodon), niu bang zi (burdock seed), gao ben (ligusticum), chuan xiong (cnidium), man jing zi (vitex fruit), qin jiao (gentian), tian ma (gastrodia), ma huang (ephedra), jing jie sui (schizonepeta spike), bo he (mint).

② Heat floating and growing — matches summer. Herbs with thick qi, yang within yang; thick qi generates warmth, acrid-sweet and warm in nature. Their action floats and grows. Examples: fu zi (aconite), wu tou (aconite root), rou gui (cinnamon bark), gui zhi (cinnamon twig), mu xiang (costus root), ding xiang (clove), bai dou kou (cardamom), cao dou kou (katsumadai seed), yi zhi ren (alpinia fruit), chuan jiao (Sichuan pepper), gan jiang (dried ginger).

③ Damp transforming and completing — matches long summer, the center. Herbs that build the spleen earth, supporting the spleen and stomach, supporting qi and blood. Examples: ren shen (ginseng), huang qi (astragalus), gan cao (licorice), dang gui (angelica sinensis), shu di huang (prepared rehmannia), ban xia (pinellia), bai zhu (atractylodes), cang zhu (black atractylodes), ju hong (tangerine peel).

④ Dry descending and receiving — matches autumn. Herbs with thin qi, yang within yin; thin qi disperses and discharges, acrid-sweet, bland, neutral or cool. They drain water-damp downward, governing descent and collection. Examples: fu ling (poria), zhu ling (polyporus), ze xie (alisma), hua shi (talc), along with tian men dong (asparagus root), mai men dong (ophiopogon), xi jiao (rhinoceros horn).

⑤ Cold sinking and storing — matches winter. Cold, cooling herbs that sink down and store away. Examples: da huang (rhubarb), huang bai (phellodendron), huang qin (scutellaria), huang lian (coptis), shi gao (gypsum).

Now back to Counselor Shang: his body was cold, yin-cold — he was stuck in a “winter” pattern. What do you do with a winter pattern? You move him into a summer pattern, so you use nothing but summer herbs — the heat-floating-growing category, meaning gan jiang and fu zi.

💬 Note from Doctor Luo: This is one of the playful things about studying Chinese medicine — it’s full of models. This school’s model is adjusting your personal seasons: whatever state your body has drifted into, the doctor files you into the matching season. When the mapping is right, you’re healthy; when it’s wrong and you’ve fallen out of your season, he pulls you back. This patient’s body had gone abnormal and entered the cold pattern, so he used acrid-sweet, strongly heating herbs to drain the cold water, and paired them with the damp-transforming pattern — when the spleen is insufficient, supplement it with sweetness. He used ren shen, bai zhu, gan cao and chen pi, bitter-sweet and warming, to build the spleen earth, because the spleen earth is the root of the body.

The remaining herbs were all matched according to the same “pattern” logic:

• Sheng jiang (fresh ginger) and cao dou kou (katsumadai seed) — acrid and warm, treating cold invading the stomach: the patient feared cold and had no appetite, the external cold evil had injured the spleen and stomach, and these warming herbs correct it (they too belong to the summer pattern);
• Hou po (magnolia bark) — acrid and warm, thickening and steadying the intestines;
• Bai fu ling (poria) — sweet and neutral, helping the organs and removing dampness, strengthening the spleen and draining damp (it belongs to the autumn dry-descending pattern);
• Bai shao (white peony root) — softening and calming the liver.

The formula is dominated by the summer pattern, with a little long-summer spleen-building added, and a little autumn damp-drying on the side — the hierarchy is clear.

The bai shao is a particularly fine touch. Counselor Shang was a serving official, endlessly overworked, with his liver qi chronically constrained. Bai shao softens the liver — it calms and restrains the liver qi so it can’t get too pent up.

💬 Note from Doctor Luo: In fact, when bai shao is used in diarrhea patients, its main job is softening the liver. Diarrhea is very often tied to bad mood and stress — that’s a major causative factor. Put in bai shao to soften the liver and dissolve the liver qi stagnation, and the diarrhea diminishes considerably. That’s the Chinese medicine way of thinking.

The result: a few doses, and the illness was gone

This formula is the famous Fuzi Wenzhong Tang recorded in the Weisheng Baojian (The Precious Mirror of Health), specifically for people of insufficient yang qi who catch cold evil and develop abdominal pain with spontaneous diarrhea (fu tong zi li), undigested food in the stool (wan gu bu hua), weak spleen and stomach, no appetite, reluctance to speak, fatigue — the state where upright qi is wounded, yang qi insufficient, and each bout of diarrhea makes the deficiency worse.

After taking it, Counselor Shang recovered after only a few doses.

💬 Note from Doctor Luo: That’s Doctor Luo Tianyi — profound skill. He could get patients better in just a few doses, which is genuinely remarkable. Physicians of this caliber in ancient times prescribed with real method, and with striking clarity.

Doctor Luo Dalun’s closing note: this school never prescribed blindly

What distinguishes Doctor Luo Tianyi’s school of physicians above all? They never used medicines blindly.

They kept one Neijing — and following the treatment principles inside it, they filed every medicine into the pattern of the four seasons. When they saw a patient, they didn’t look at isolated symptoms; they asked: what pattern is your body in, and which season should it be in? You’re in winter now — how do I move you to summer? How? Take out the summer herbs and turn the state of the body around.

This “Images of Medicinal Use” theory is not widely practiced today. Some practitioners in the field use something like the principle, but very few explain it as clearly as Zhang Yuansu did.

💬 Note from Doctor Luo: This system was Zhang Yuansu’s invention. He taught Doctor Li Dongyuan, whose skill was so superb that he was hailed as a physician of the realm; and Doctor Li Dongyuan in turn taught Doctor Luo Tianyi — the best doctor, immediately chosen to serve as imperial physician in the palace. It’s a fascinating lineage. Chinese medicine holds countless treasures that haven’t yet been fully excavated. In my view the Images of Medicinal Use could serve perfectly as an introductory course for Chinese medicine enthusiasts: which medicines, by their nature and flavor, belong to the rising or the descending, which season of the year they fit, and how to use them — all worth studying carefully.

A bonus: one thin little book hiding a great treasure of medicinal knowledge

Doctor Luo Dalun adds a special reminder: if you ever get the chance, pick up a book by Zhang Yuansu and read it.

Zhang Yuansu’s writings are extremely thin — just a little booklet — yet their standing in the history of Chinese medicine is very high. Later generations discussing medicinal herbs constantly invoke “what Zhang Yuansu said, what Li Dongyuan said” — the teaching of that master-and-disciple pair.

Why? Because once they had filed medicines into the pattern of the four seasons, their prescribing became exceptionally precise, and they developed special insights into the herbs. Those insights enriched the application of Chinese herbal medicine — content that simply didn’t exist before, that they supplied.

💬 Note from Doctor Luo: So these were true masters of Chinese medicine — masters who recorded history. This is an opportunity worth looking into.

Case source: the Weisheng Baojian (The Precious Mirror of Health) by Doctor Luo Tianyi (completed c. 1281, Yuan dynasty); commentary based on public lectures by Doctor Luo Dalun (PhD in TCM diagnostics, Beijing University of Chinese Medicine).