Half a Year of Diarrhea and Growing Weaker Every Day? Doctor Zhang Xichun’s Fu Zhong Tang (Support the Middle Decoction) Rebuilt Her Spleen with Three Herbs
Patient’s search terms: chronic diarrhea / long-term loose stools / drained by diarrhea / cold sweats / heart racing and palpitations / body weakness Medical terms: chronic diarrhea (jiu xie, 久泻) · deficiency of both qi and blood · spleen weakness with poor transportation · dual deficiency of heart and spleen
Remember the yam porridge? Today we meet its upgraded version
Earlier we talked about how Doctor Zhang Xichun treated chronic diarrhea — the kind where the stool never holds its shape, the bowel movement slips out all at once, without the normal process — with a favorite trick: the yam porridge (shu yu zhou, 薯蓣粥), made from Chinese yam simmered into gruel. For ordinary chronic diarrhea, that porridge alone usually does the job.
💬 Note from Doctor Luo: The yam porridge was Doctor Zhang Xichun’s foundation formula for chronic diarrhea, but he never expected one trick to cure everything. When a particular patient still didn’t recover, he kept upgrading the formula — and what we’re about to see today is the upgrade of the upgrade.
The patient: a woman in her forties, who started with “heat in her heart”
Today’s patient was a woman in her forties. How did her illness begin? At first she constantly felt hot inside her chest — what Doctor Zhang Xichun always described as “heat in the heart” (xin zhong fa re, 心中发热): a sensation of inner heat, restlessness, and a feeling that her qi was stuck and not flowing freely.
So she consulted a doctor, who prescribed heat-clearing, qi-regulating medicine and told her to keep clearing the heat.
💬 Note from Doctor Luo: Pay attention — that medicine was almost certainly cold and cooling in nature. A great many cases of chronic diarrhea start because someone ate something too cold and hurt their spleen and stomach, or took cold-natured medicine that damaged the yang qi of the spleen and stomach, leaving a permanent root of diarrhea behind. This woman was a textbook case.
And here’s the trouble: once she took the cold medicine, the diarrhea never stopped
After taking the medicine, she developed a new problem — she began to have endless diarrhea, a chronic, unrelenting looseness. She called in other doctors. They looked at the situation and thought: “The cold medicine caused the diarrhea, so let’s use warming, tonifying medicine — heat it up!”
At first it seemed to work a little, but then it stopped working, and the diarrhea refused to stop. She was running to the toilet four or five times a day and night — thoroughly miserable.
💬 Note from Doctor Luo: There’s a detail worth pondering here: the warming medicine worked at first but not on repeat doses. That tells us plain warming and tonifying had never truly rebuilt the foundation of the spleen and stomach. This diarrhea was not something one simple tonic could pin down.
Six months of failure — she was weak to the bone and labeled “incurable”
The condition dragged on for six months without improving, and her body grew weaker and weaker — severely weakened. In the end, everyone concluded: this is an incurable disease.
💬 Note from Doctor Luo: Think about why. With long-term diarrhea, the nutrients in food simply can’t be absorbed. Both qi and blood are exhausted — the body is depleted, so of course it gets weaker and weaker. Some illnesses look untreatable when really they were just dragged out too long.
Doctor Zhang Xichun arrives: one pulse reading, and he says “it can be treated”
At wit’s end, the family called in Doctor Zhang Xichun. He took her pulse and felt it could be treated — the body was badly drained by months of diarrhea, but there was still hope.
Look at her condition: drenching cold sweats — she sweated heavily without strength; fluttering palpitations — her heart raced with anxiety; loss of appetite — she could barely eat.
💬 Note from Doctor Luo: Read those three together and the picture is clear. The drenching cold sweats show the upright qi (zheng qi, 正气) can no longer hold itself up. The palpitations mean the problem has reached the heart. The loss of appetite means the spleen and stomach are wounded too. Months of diarrhea had exhausted both qi and blood, and every organ suffered along with it. Doctor Zhang Xichun said: all right, I’ll write you a prescription.
The prescription revealed: Fu Zhong Tang — “three great generals,” yam, atractylodes and longan
The formula was called Fu Zhong Tang (Support the Middle Decoction). What’s in it? First, one liang (about 30 g) of raw huai shan yao — dried Chinese yam slices, to tonify the spleen. Then one liang of bai zhu (atractylodes), the variety grown in Yuqian in Zhejiang, stir-fried, to tonify the spleen and drain dampness. And finally one liang of long yan rou (longan pulp), to tonify the spleen and nourish the heart.
💬 Note from Doctor Luo: Look at these three generals: yam tonifies the spleen, atractylodes tonifies the spleen and drains dampness, longan tonifies the spleen and nourishes the heart — all three at heavy doses of one liang each, all aiming in the same direction: first raise up the foundation of the spleen and stomach. That’s why the formula is called “Support the Middle” — it supports the middle jiao, the spleen and stomach. And how did it work? She took it, and the results were good!
Twist one: the diarrhea stopped — but suddenly the sweating got worse
After a few doses, the diarrhea stopped. But then everyone noticed: once the diarrhea stopped, the sweating increased. Strange — why would stopping the diarrhea make her sweat more?
Doctor Zhang Xichun said: we need to rein this in. So he added six qian (about 18 g) each of long gu (dragon bone) and mu li (oyster shell) to the formula — both used raw, not calcined. After two doses, the sweating stopped too.
💬 Note from Doctor Luo: Doctor Zhang Xichun’s pacing was very steady: diarrhea stopped, so he watched the sweating — sweat is the body’s qi leaking outward, so he hurried to seal it in with dragon bone and oyster shell. But the story wasn’t over. Press down the gourd and the dipper floats up — a new problem appeared.
Twist two: the sweating stopped — but now her body swelled slightly. Which exit should the water take?
After the sweating stopped, the woman became mildly swollen all over. Doctor Zhang Xichun took one look: all right, press down the gourd and up floats the dipper.
Why did this happen? Here’s the logic: while she had diarrhea, her urine was scanty — most of the water was leaving through the stool, so urine output dropped. When the diarrhea stopped, the water still wasn’t leaving through urine — so where did it go? It came out through sweat! What does that tell us? The bladder’s qi transformation was impaired — its ability to drain water through urine wasn’t working properly. And when you also stopped the sweating, the water had no way out at all, so the whole body swelled slightly.
💬 Note from Doctor Luo: This passage is especially brilliant — it explains the balanced distribution of water metabolism in the body: stool, urine and sweat are three connected exits. When one is blocked, the water shows up through another — less urine means more sweat, and stopping the sweat brings swelling. So Doctor Zhang Xichun said: then we’ll add one more herb to the formula.
The finishing touch: a single herb — three qian of jiao mu — and ten doses to full recovery
Which herb did Doctor Zhang Xichun add? Jiao mu (prickly ash seed), three qian — about nine grams — and he specifically wanted it stir-fried and crushed. What is jiao mu? The seed of the Sichuan pepper (huajiao, 花椒) — when the pepper matures and splits open, you remove the outer shell, and the seed inside is jiao mu.
💬 Note from Doctor Luo: Doctor Zhang Xichun added three qian of jiao mu — about nine grams — deliberately stir-fried and pounded. What can this herb do? It specializes in opening the urine and draining water-dampness. Ancient doctors used it for edema. With jiao mu added, the water drained out through the urine. And the result? After ten consecutive doses, the patient was cured, and her body began to recover.
Bonus one: pepper skin versus pepper seed — how finely ancient doctors used herbs, and the wisdom hiding in your hotpot
The most intriguing herb in this formula is jiao mu. The herb we normally use is called chuan jiao (Sichuan pepper) — and normal use takes the skin of the pepper seed, the outer shell. What does pepper skin do? It warms the yang — it can warm yang and drive out cold-dampness.
And the seed inside the shell — jiao mu? It leans toward promoting urination and draining water. Both warm yang and resolve dampness, but the pepper skin leans toward warming yang and dispersing cold, while jiao mu leans toward draining water and reducing swelling — each has its own job.
💬 Note from Doctor Luo: You see, ancient Chinese doctors were extremely precise: to warm yang and scatter cold, take the pepper’s skin; to promote urination alone, take the seed inside. Now do you understand why Sichuan hotpot is always full of Sichuan pepper? Winters there are cold and damp, so pepper drives out the cold; the air is thick with moisture, and pepper dries the dampness — this is the dietary wisdom of ordinary people. When we cook hotpot, we probably toss the skin and the seeds in together and boil them all.
Bonus two: a little longan secret for the heart — for racing heart, palpitations and fluttering
In this case record, Doctor Zhang Xichun also devoted a special passage to longan pulp.
He said: longan pulp tastes sweet, so it tonifies the spleen — sweet flavors strengthen spleen qi; it’s fragrant, and fragrance awakens the spleen — so it is the essential herb of the spleen family, truly the most important herb for the spleen and stomach. Moreover, the heart is the mother of the spleen: the heart belongs to fire, the spleen to earth, and fire generates earth. Longan pulp is red in color, so it enters the heart — once dried, it turns red, enters the heart channel, and nourishes the heart. When the mother is strong, the child naturally benefits.
💬 Note from Doctor Luo: Doctor Zhang Xichun added that when he treated heart fluttering (xin zhong zheng chong, 心中怔忡) — the racing, skipping heart caused by heart deficiency, what we’d call palpitations or premature beats today — he would often buy more than a catty of longan pulp, steam it soft with the rice, and have the patient eat it slowly over time, and it worked remarkably well. That’s clear proof it tonifies the heart. So you see: pair longan with yam, pair atractylodes with yam, and you can reset the weakened state left behind by diarrhea — that’s the new approach we’re learning today.
Wrapping up: Doctor Zhang Xichun’s three upgraded versions of yam for diarrhea
Let’s trace Doctor Zhang Xichun’s thinking: for chronic diarrhea, version one was the yam porridge, shu yu zhou. When that wasn’t enough, version two added ji zi huang (egg yolk). And for people whose diarrhea had gone on so long that qi and blood were exhausted and the body was weak, version three is today’s Fu Zhong Tang — the three great generals: yam, atractylodes and longan.
💬 Note from Doctor Luo: One upgrade after another, each more complete than the last. Learning this way, we gradually understand how to use yam — and why Doctor Zhang Xichun prescribed the way he did. A single yam on its own may be too thin; paired with atractylodes and longan, it can rush the upright qi back up even when the body is at its weakest.
What to take away: long-term diarrhea drains both qi and blood, and the body announces the damage in three ways — drenching cold sweats, a fluttering heart, and no appetite. Doctor Zhang Xichun’s answer was not a complicated cocktail but three heavy, single-minded herbs — yam, atractylodes and longan — to “support the middle,” then a steady sequence of small additions: dragon bone and oyster shell to seal the sweating, and a single seed, jiao mu, to send the water out through urine. Watch how he let each new symptom point to its own herb — that is the art.
That’s all for today, friends. Tomorrow we’ll continue with how Doctor Zhang Xichun used Chinese yam. Goodbye!
Compiled from Doctor Luo Dalun’s commentary on Doctor Zhang Xichun’s case records; the case is from Records of Chinese Medicine with Reference to the West (《医学衷中参西录》).