Diarrhea With Undigested Food and Cold Hands and Feet? Doctor Luo Tianyi’s Case of Cold Diarrhea After Summer Cold Drinks

What people search for: diarrhea with undigested food / diarrhea after cold drinks / cold hands and feet / thirsty but not wanting to drink / red face with red patches on the skin / irritable in the afternoon Corresponding medical terms: internal cold (nei han) · spleen-stomach vacuity cold · cold-dampness trapping the spleen · xia li qing gu (diarrhea with undigested food) · xu yang wai yue (floating of vacuity yang)

Opening scene: turn to the last page of the medical book, and the case was written by the patient’s friend

Doctor Luo Tianyi’s (styled Qianfu) Weisheng Baojian (The Precious Mirror of Health) — the book we have been following — has now reached its final case. Why save this one for last? Doctor Luo Dalun explains: Doctor Li Dongyuan’s scholarship passed down to Doctor Luo Tianyi, and in the clinic Doctor Luo Tianyi put that learning to use with complete mastery — after walking through all his cases, one comes away with a direct, intuitive feel for Doctor Li Dongyuan’s academic thought.

And this case has one more special feature: it was not written by Doctor Luo Tianyi himself, but recorded by the patient’s friend.

💬 Note from Doctor Luo: The friend who wrote it up was named Hao Daoning, and the patient was his good friend Liu Juyuan. When Liu Juyuan fell ill, Doctor Luo Tianyi was called in, and Hao Daoning stayed at the bedside every day watching — the more he watched, the more he admired it, sighing “this learning is truly great,” and so he wrote down the entire course of diagnosis and treatment with his own hand and appended it to the end of the Weisheng Baojian. Because this case is written from an outsider’s perspective, the details are especially trustworthy.

Who was the patient: Liu Juyuan, sixty-five, felled in the height of summer

This Liu Juyuan was sixty-five that year — past the age of sixty, no longer young.

How did the illness arise? Three factors piled on top of one another:

Labor and fatigue — overexertion, too much consumption;
Unregulated diet — unsuitable food, irregular meals;
Injury from cold drinks — in the great heat, drinking too many ice-cold things.

💬 Note from Doctor Luo: Note the timing — summer. When the weather is hot, people crave coolness, and one cold drink follows another. This old gentleman was already old, his upright qi (zheng qi) naturally weak; on top of that he was fatigued and eating poorly, so his spleen-stomach was already vacuous when a bellyful of cold drinks went down and directly injured the yang qi of the spleen-stomach. This is the classic “in the great heat of summer, contracting an internal cold pattern.”

How the illness went wrong: treated as an external contraction for ten-odd days, it only got worse

After he collapsed, the doctors called in first all said it was a “pattern of the four seasons” — meaning they thought he had an externally contracted disease, an epidemic brought on by weather changes and imbalance of cold and heat.

So they treated it as an external contraction — for ten-odd days, with no improvement at all.

💬 Note from Doctor Luo: The phrase “pattern of the four seasons” is how the ancients summarized externally contracted seasonal disease — the weather changes through the four seasons, cold and heat differ, and a person who is affected easily falls ill. This man was treated as an externally contracted disease for more than ten days, and the more he was treated the worse he became, which is why Doctor Luo Tianyi was finally called in.

When Doctor Luo Tianyi arrived, he first took the pulse and immediately saw what was going on:

The three positions on the right hand: deep, thin, and faint — insufficient upright qi, the disease is in the taiyin (spleen);
The three positions on the left hand: slightly floating and wiry — there is vacuity yang floating at the surface.

He rendered a judgment in eight characters: by and large, yin is abundant and yang is scarce.

💬 Note from Doctor Luo: What does this mean? Inside the body, the vacuity cold of the taiyin spleen is abundant; outside the body, yang qi is scarce, with only a little vacuity yang putting on a show. So this is primarily a cold pattern — the “heat” at the surface is an illusion; cold is the truth.

How severe the illness was: diarrhea of undigested food, cold hands and feet, yet a red face

Liu Juyuan’s full set of symptoms, Doctor Luo Tianyi recorded clearly:

Heavy body — the body felt especially heavy, without strength;
Cold extremities — hands and feet ice cold, cold to the touch;
Xia li qing gu — diarrhea, and what came out was not brownish but thin and clear, carrying undigested food;
Pulling clothes over oneself — always wanting to drag clothes over the body, feeling cold;
Labored breathing and reluctance to speak — short of breath, not wanting to talk.

Doctor Luo Tianyi summed it up in one sentence: “This is the spleen receiving cold-dampness, hence insufficiency of the middle qi.” The disease is in the foot-taiyin spleen channel; the spleen received cold-dampness, the middle qi became insufficient, and that is why this whole set of symptoms appeared.

But that was not all — he had another group of far more deceptive symptoms:

Dry mouth, wanting to drink, yet when the water reached the mouth he could not swallow it — only wanting to rinse and spit it out;
In the morning the body felt cold, with goosebumps rising on the skin;
In the afternoon he easily grew irritable, yet though irritable, he did not want to take his clothes off;
Drowsy and sleepy, yet the face was red;
Faint red patches floating on the skin.

💬 Note from Doctor Luo: Dry mouth, red face, red patches on the skin — put these three together, and how many doctors would treat it as a heat pattern? But Doctor Luo Tianyi said: this is exterior repletion with interior vacuity. The interior vacuity cold is the root; the “excess heat” on the outside is all illusion. Why the false heat? Vacuity yang floating outward — when the cold qi inside the body is too abundant, the yang qi has nowhere to stay and can only run outward; once it reaches the body surface, it stages a performance of “heat pattern.” If at the sight of a red face you administer heat-clearing herbs, you are in serious trouble.

The key to pattern discrimination: see a red face and rash, so clear heat? That would be a mistake

Doctor Luo Tianyi stressed a famous maxim: “When the interior is vacuous, the exterior signs change with the time.”

💬 Note from Doctor Luo: This sentence is especially important — the vacuity inside is the root, and the exterior signs change along with it. When the interior vacuity is severe, the exterior signs change; when the interior vacuity is mild, the exterior signs change too. And the change is “with the time” — it follows the season: in summer the weather outside is hot, so the vacuity yang easily makes a showy heat pattern on the surface; in winter, that heat pattern is not so conspicuous. So when you examine an illness, you must grasp the root inside and not be dazzled by the changing appearances outside.

He “examined the interior and exterior signs in detail,” sizing them up for a long while, and concluded: the root of the illness is inside — it came from diet, fatigue, and cold injuring the spleen-stomach, not at all a “four seasons” externally contracted disease; treating it as a cold would never cure it.

Then how to treat? The difficulty lay precisely in the season:

By the rules of summer one should use cool, clearing herbs — but this man had internal cold, and clearing herbs would be wrong;
By the rules of the disease one should warm with hot herbs — but it was the height of summer, and fierce hot herbs risked injuring the upright qi.

When both cold and heat would harm, one must put weight on treating from the middle — take the middle road: not great heat, but warmth — warm and tonify the spleen-stomach.

Using heat while keeping far from heat: Doctor Zhang Zhongjing said Sini Tang, but it was the dog days of summer

At this point Doctor Luo Tianyi cited two classics and maneuvered himself into a genuine dilemma:

On one side, Doctor Zhang Zhongjing. The Shanghan Lun (Treatise on Cold Damage) says that if there is xia li qing gu — diarrhea of thin, clear, undigested matter — then there must be cold in the abdomen, cold evil in abundance, and one should “treat the interior”; with what? Sini Tang (the Four-Counterflow Decoction) — the great hot herbs fuzi (aconite) and gan jiang (dried ginger) and the like.

On the other side, the Huangdi Neijing (Yellow Emperor’s Inner Canon). The Neijing says: “When using heat, keep far from heat.” — when using especially hot herbs, stay as far as possible from the hot season. Do not use great hot herbs in the great heat, nor great cold herbs in the great cold.

💬 Note from Doctor Luo: Why? Even though they can cure disease, great hot herbs also affect the upright qi. The school of Doctor Li Dongyuan and Doctor Luo Tianyi took this principle very seriously — they truly avoided especially hot herbs in high summer and especially cold herbs in deep winter. Doctor Zhang Zhongjing said xia li qing gu should be warmed with Sini Tang, but the Neijing says use heat while keeping far from heat — in summer one cannot be so fierce; both are right, so one must weigh and deliberate. Out of that deliberation came the treatment principle of “putting weight on the middle.”

So Doctor Luo Tianyi chose the path of warming and tonifying the spleen-stomach and wrote out an unexpected prescription — Qianshi Baizhu San (Qian Yi’s Atractylodes Powder).

Dissecting the prescription: a famous pediatric formula, used by Doctor Luo Tianyi to save an old man

Where did this formula come from? It appears in the Taiping Huimin Heji Ju Fang (Formulary of the Pharmacy Service for Great Peace and Universal Welfare) and also in Doctor Qian Yi’s Xiao’er Yaozheng Zhijue (Key to the Diagnosis and Treatment of Children’s Diseases) — hence the name “Qian’s,” the formula from Doctor Qian Yi’s book.

What was it originally for? Treating children: when a small child has violent diarrhea — the spleen-stomach vacuous and cold, pouring down after receiving vacuity cold until the fluids are insufficient, with severe vexation and thirst, an extremely poor appetite, refusing milk and food, and a very weak body — this formula warms and tonifies the spleen-stomach and restores the upright qi.

The composition is not complicated — seven herbs in all — and Doctor Luo Tianyi took them apart one by one:

Ren shen (ginseng) — tonifies the upright qi, engenders fluids;
Bai zhu (atractylodes) — tonifies the spleen;
Mu xiang (costus root) — moves the qi. Someone asks: with diarrhea this violent, why still move dampness out? Because next comes fu ling —
Fu ling (poria) — removes dampness by promoting urination. Diarrhea means the water is leaving through the intestines; once urination is promoted and the water leaves through the urine, the water in the stool decreases. This is called “promoting urination to firm the stool”;
Huo xiang (patchouli) — moves the qi of the spleen-stomach; aren’t you vacuous and cold? Move the spleen-stomach qi open;
Gan cao (licorice) — warms the middle and tonifies the spleen;
Ge gen (kudzu root) — relaxes the muscles and abates fever (violent diarrhea brings vacuity heat), engenders fluids and stops thirst (the fluids are already greatly injured), and also has the function of freeing the network vessels.

💬 Note from Doctor Luo: In using this formula, Doctor Luo Tianyi deliberately added one more herb — sheng ma (bugbane root) — to raise the yangming qi. Why? Because with such violent diarrhea, the whole qi mechanism is moving downward; he used sheng ma to prop the qi up and lift it. That single stroke shows real skill.

He himself summarized the formula’s intent in three sentences:

Ge gen combined with gan cao is the foundation, to relax the muscles — resolving the layer of red patches on the surface;
Bai zhu and fu ling remove dampness and promote urination — the water leaves through the urine, and the stool naturally forms;
Ren shen, huo xiang, and mu xiang settle the spleen-stomach and restore the appetite.

The herbs were ground into a fine powder, one liang (about 30 g) per dose, decocted in water.

The effect and the formula switch: after two doses the rash receded and the body warmed; two small formulas finished the job

The medicine took effect at once — after the second dose, the rash receded and the body warmed: the red patches on the skin went away and the body warmed up; the diarrhea stopped and the spirit returned: the diarrhea ceased and his energy picked up a bit.

As soon as the diarrhea stopped, Doctor Luo Tianyi immediately switched formulas — notice how he treated: he never prescribed seven doses of one formula and told you to come back in a week; instead he changed as soon as there was improvement, advancing step by step.

The replacements were two small pungent-warm formulas, both from Doctor Qian Yi’s Xiao’er Yaozheng Zhijue:

The first, Yigong San (the Extraordinary Merit Powder). It is Si Jun Zi Tang (the Four Gentlemen Decoction) — ren shen, bai zhu, fu ling, gan cao — plus chen pi (tangerine peel). The Four Gentlemen tonify qi and spleen; why add chen pi? Because tonics fear not being able to get in. When the spleen-stomach has been vacuous and weak for a long time, qi stagnation tends to block things up inside; add a little chen pi to move the qi open, and then the tonics can enter. It treats spleen vacuity with qi stagnation specifically: reduced appetite, a stifling sensation in the chest, unformed stools, fatigue with shortness of breath, a thin and weak body, and in severe cases edema.

The second, Zhizhong Tang (the Regulate the Middle Decoction). Also spleen-tonifying, similar to Yigong San: ren shen, bai zhu, fu ling, gan cao, chen pi, plus gan jiang (dried ginger) and qing pi (green tangerine peel) — carrying a bit of warmth, warming and tonifying the spleen-stomach.

💬 Note from Doctor Luo: Do you see? The Yishui school of the master-disciple line Doctor Zhang Yuansu, Doctor Li Dongyuan, and Doctor Luo Tianyi — where did its theoretical lineage come from? From Doctor Qian Yi. Doctor Qian Yi attached great importance to the spleen-stomach and created these formulas — scholarship is handed down generation by generation in just this way. The formulas of this school look simple, but the tradition behind them runs deep.

Each formula was taken once or twice, and after five days the body was completely settled — not a symptom left.

Stop the medicine! Healing without medicine, treating without treatment

Once the illness was cured, Doctor Luo Tianyi said: stop the medicine; no more doses.

Liu Juyuan, in fact, was a little uneasy: “My illness is temporarily better, but to stop the medicine like this — is that all right?”

Doctor Luo Tianyi’s reply is the finishing stroke of this case:

Medicine is for attacking evil and curing disease. The Neijing says: “Treat disease by taking evenness as the standard” — once the symptoms are gone, stop. The evil qi has departed; if you force the medicine anyway, insisting on taking more, other symptoms may even appear. At such a time it is better to nourish with diet and await the return of true qi — this is the principle of “healing without medicine, treating without treatment.”

Hearing this, Liu Juyuan felt it made sense and complied. After about ten days, his body was completely well.

💬 Note from Doctor Luo: This passage is very important — many people think Chinese medicine is all about taking herbs, and the more the better. But an expert like Doctor Luo Tianyi stops the medicine the moment the illness settles, and leaves the recovery to dietary care. Grains and staples nourish the spleen-stomach, and the true qi comes back on its own, slowly. Only someone who truly understands the Neijing could say such a thing.

Hao Daoning’s admiration: this is an imperial physician, not a man who flips through books hunting formulas

As a witness to the whole process, Hao Daoning closed the case with a long outpouring of admiration:

“Qianfu practices medicine having deeply studied the intent of the Neijing; he takes the classics as his basis and is not moved by the talk of the crowd. His breast is clear and unblocked, without any obstruction — how could this be compared to those who use tested formulas and search the books for prescriptions?”

💬 Note from Doctor Luo: What does it mean? Doctor Luo Tianyi as a physician truly studied the Neijing to the bottom; everything rests on the classics, and no one’s opinion could sway him; in his mind the illness stood clearly revealed, without a single obstruction. How could this be compared to those doctors who carry tested formulas and flip through books looking for prescriptions? — This was an imperial physician, a disciple of Doctor Li Dongyuan, a master among masters.

Doctor Luo Dalun’s closing note: the Earth-Tonifying school’s medicine never intended you to take it for six months

After finishing this case, Doctor Luo Dalun spoke his own reflections:

💬 Note from Doctor Luo: Studying this case, I was deeply inspired — I too had assumed that doctors of the spleen-tonifying school surely excel at prescribing spleen-tonifying herbs, to be taken for months, half a year. Not so. In treating this man they took medicine for only a few days in all, and then told him: dietary care. Every medicine is medicine; use medicine only to stabilize the situation, and let the recovery depend on food therapy. Doctor Li Dongyuan and his school were especially particular about “knowing when to stop,” and after stopping, they regulated with grains and staples, waiting for the upright qi to return — this thinking is a great inspiration for our health preservation today.

Bonus: grains and staples are the best medicine

That is why Doctor Luo Dalun values food therapy so much — this is not casual talk:

💬 Note from Doctor Luo: Why do I place such weight on food therapy? I am always telling people about grains and staples, and constantly recommending five-grain powder — shan yao (Chinese yam), lian zi (lotus seeds), yi mi (job’s tears) and the like ground into powder, taken regularly in small amounts. This is the experience of the great physicians of antiquity: use medicine to stabilize the situation, then use food to nurse the spleen-stomach back. The Earth-Tonifying school is rich in experience and solid in theory, but their spleen-tonifying medicine would never be prescribed to you for six months — it stops at a certain point, and then comes grains, staples, and dietary care. This wisdom is worth learning for every one of us.

Epilogue: the case series is complete; tomorrow, the formulas of Doctor Li Dongyuan

With this final case of the Weisheng Baojian told, the series on Doctor Luo Tianyi’s cases comes to a close. Doctor Luo Dalun previewed what comes next: the formulas of Doctor Li Dongyuan — the classic formulas of Bu Zhong Yi Qi (Tonify the Middle and Boost Qi) and Sheng Yang Yi Qi (Raise Yang and Boost Qi), sorted out one by one.

💬 Note from Doctor Luo: Why tell the cases first and the formulas after? Because everyone will immediately see: these formulas grew out of what academic thought. Look at the cases first, then the formulas, and the line of reasoning opens right up. Doctor Li Dongyuan’s formulas are especially classic; after I finish them, I hope they will inspire you even more.

He also mentioned something that moved him: that day he read letters from readers of the WeChat public account “Daluan Shuyuan (the Great Academy)”, and found that many friends were listening attentively, and in many corners he had never imagined, people were studying — this moved him deeply and gave him even more motivation to keep telling the cases of these great physicians of antiquity one by one, slowly.

💬 Note from Doctor Luo: Tomorrow, we’ll meet again, and continue with Doctor Li Dongyuan’s classic formulas. Thank you, everyone!

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

📋 Case Details