Bloody Diarrhea and the Urge That Wouldn’t Stop? Doctor Zhang Xichun Treated Heat Dysentery with Raw Gypsum and Ginseng
Patient search terms: diarrhea with blood / tenesmus / feeling the urge to go but unable to pass much / diarrhea that won’t heal for over twenty days / heat inside the intestines Medical terms: dysentery · heat dysentery · latent pathogen transforming into heat
Opening: Mid-Autumn Festival, and a 67-year-old man comes down with dysentery
Today we continue our series on Doctor Zhang Xichun (张锡纯) and his use of raw gypsum (sheng shi gao, 生石膏). In earlier episodes we saw him use gypsum to clear heat from the surface and to drive out lurking heat. Today’s application is even more clever — he used raw gypsum together with ginseng to treat diarrhea.
💬 Note from Doctor Luo: Notice this, everyone. The moment anyone hears “diarrhea,” the first thought is usually “did he eat something bad, or catch cold?” — and the medicine used is the astringent, warming kind. But in this case Doctor Zhang Xichun did the very opposite: he used raw gypsum in heavy doses, and paired it with ginseng. Hidden inside is a big principle — heat pathogens can cause diarrhea too.
Who was the patient? Wang Hexuan from Doctor Zhang’s home village, aged 67
The patient was named Wang Hexuan (王和轩), a man from Doctor Zhang Xichun’s home county (Yanshan, Hebei). That year he was 67 years old, and he came down with dysentery at Mid-Autumn Festival.
💬 Note from Doctor Luo: Sixty-seven — no longer young. And Mid-Autumn is a season of change. When an elderly man gets dysentery at such a time, you can be sure the family was frantic.
How bad was it: red-and-white jelly passing down, and heat burning inside the intestines
What did the dysentery look like? Tenesmus — the most typical feature of dysentery: the abdomen bears down in waves, urging the patient to the toilet, yet when he gets there, very little comes out — and the belly still hurts afterward. By the time the family called in Doctor Zhang Xichun, this old man had already been treated for more than twenty days with absolutely no effect.
When Doctor Zhang Xichun asked about the details, this is what he heard: what came out was red-and-white gelatinous material — patches of deep and light color, passing like jelly; he constantly felt hot and dry inside the intestines, and his urine also felt hot; his abdomen bore down, and even his tailbone (the lower end of the spine) ached with that bearing-down sensation; and he felt dizzy.
💬 Note from Doctor Luo: Listen to that string of symptoms: heat in the intestines, hot urine, bearing-down in the belly, tailbone pain, dizziness — this is not an ordinary case of diarrhea. This is heat stirring up trouble inside.
The pulse: flooding, long and forceful — yet a tongue coated white like powder
Doctor Zhang Xichun felt the pulse: flooding, long and forceful — telling him there was heat inside. Then he looked at the tongue: the coating was thick and white.
Here’s the puzzle: if there’s heat, shouldn’t the tongue coating be yellow? Why is it white?
💬 Note from Doctor Luo: Doctor Zhang Xichun explained it this way: it’s because an external pathogen is mixed in — with turbid dampness tangled in, the coating turns thick and white, pasted over the tongue like accumulated powder. So a white coating does not always mean cold — you have to read it together with the pulse and the whole-body picture. A flooding, forceful pulse is the hardest evidence of heat there is.
Doctor Zhang Xichun’s diagnosis: external heat carrying pestilent poison, pressing downward
Doctor Zhang Xichun’s judgment: this was external heat, carrying pestilent poison (li qi, 戾气), pressing downward against the intestines. That was why all these symptoms burst out at once.
💬 Note from Doctor Luo: What is li qi? It’s the fierce, contagious kind of pathogen — what the ancients also called yi li zhi qi (疫疠之气, pestilential epidemic qi). External heat plus pestilent poison, both piled into the gut, produced this urgent, heavy dysentery. At a moment like this you must first clear the external pathogen — you can’t just stop the diarrhea.
The prescription: White Tiger plus Ginseng Decoction, with peony replacing zhi mu and Chinese yam replacing rice
Doctor Zhang Xichun wrote the formula: raw gypsum 2 liang (about 60 g), bai shao (white peony) 8 qian (about 24 g), dried Huai shan yao (Chinese yam) 6 qian (about 18 g), dang shen (Codonopsis) 5 qian (about 15 g), and gan cao (licorice) 2 qian (about 6 g).
💬 Note from Doctor Luo: Look closely — this formula is simply White Tiger plus Ginseng Decoction (Bai Hu Jia Ren Shen Tang, 白虎加人参汤) at its base. The original White Tiger Decoction is gypsum, zhi mu, licorice, and rice. Doctor Zhang Xichun made two substitutions here: peony in place of zhi mu — sometimes he uses xuan shen instead of zhi mu; this substitution method is very much his signature, and he wielded it with great flexibility — and dried Huai shan yao in place of rice, because Chinese yam tonifies the spleen, which fits this illness better than plain rice.
Doctor Zhang Xichun was particular about one thing: the yam here must be dried Huai shan yao. Sometimes he writes shan yao, sometimes huai shan yao or huai yao — he picked the form according to the severity of the illness.
Decoct it down to two teacups, and drink it warm, in two portions, one dose each day.
💬 Note from Doctor Luo: Pay attention to that detail — drink it warm. The herbs themselves are cooling, but the method is warm, so the medicine’s power can diffuse outward and scatter the heat pathogen from the inside out. Doctor Zhang Xichun was extremely careful in how he used gypsum.
Cured in two days! Then one sentence from the family planted the seeds of disaster
What happened? Two days later, the dysentery was cured! The diarrhea and the tenesmus were completely gone.
But — when Doctor Zhang Xichun felt the pulse again, there was still a little residual heat in it, and he advised: take a few more doses of raw gypsum to sweep that last bit of heat clean.
That was when the family spoke up: “The old man is 67 years old — you’ve already given him this much raw gypsum. Is that all right? Won’t it be too cold?” — and they declined. He didn’t take any more.
💬 Note from Doctor Luo: Remember this moment — it is the single most crucial stroke in this entire case. The illness was cured, yes, but the heat had not been completely cleared. A little “tail” was left hiding inside the body. The family, out of love for the old man, feared the cooling medicine would harm him — and what happened next? Trouble.
Twenty-plus days later: dysentery returned — and worse than before
At the time, Doctor Zhang Xichun had another patient to see in a different household, so he left and stopped watching over the case. More than twenty days later, the dysentery relapsed.
The family called in other doctors, and those doctors, in their dysentery formulas, added sweet, cold, moistening herbs (gan han ru run, 甘寒濡润之品) — think about it: there was already heat inside the belly, and now they were piling cooling, moistening medicines on top of it, so the heat lay hidden inside and could not come out. The result: the dysentery came and went, flaring up again and again, never getting better.
💬 Note from Doctor Luo: This is the price of failing to identify the pattern correctly. The earlier doctors saw only “diarrhea,” not “heat that was never fully cleared.” Their medicines smothered the heat back inside, and the illness dragged on into a chronic, relapsing dysentery.
The following summer: identical pulse and symptoms — Doctor Zhang saw through it in one sentence
By the next summer, the illness had grown worse, and the family had no choice but to summon Doctor Zhang Xichun again.
Doctor Zhang Xichun took one look: the pulse and the symptoms were exactly the same as the year before! He said a single sentence: this is last year’s root that was never removed — “If you had listened to me then and taken a few more doses of raw gypsum to completely clear the heat, this illness would have been gone long ago.”
💬 Note from Doctor Luo: Doctor Zhang Xichun saw through it in an instant: this was not a new illness — it was the old heat from last year that was never cleaned out. As long as the root remains, no amount of treatment will help.
Three doses in a row: cured — and it never came back
What to do? The very same formula as last year, written out exactly as before. The result: after three doses in a row, the illness was cured, the pulse was calm and harmonious, and from then on it never relapsed again.
💬 Note from Doctor Luo: Twice, the same formula; twice, it worked at once. What does that tell us? When the pattern is diagnosed correctly, one formula is enough. Last year it was almost cured — it only lacked those few extra doses of raw gypsum.
Doctor Zhang Xichun’s commentary: with ginseng’s help, the lurking heat dissipated little by little
In his notes at the end of the case, Doctor Zhang Xichun explained why the illness yielded so readily both times: it was because the gypsum received the help of ginseng, so that the heat submerged in the body rose gradually and dispersed outward, dissolving without a trace.
And why peony instead of xuan shen? Because peony matched with licorice can regulate lower-abdominal pain — peony has a relaxing action: when the intestines are in spasm, it can release the spasm. This is what Chinese medicine calls huan ji zhi tong (缓急止痛, relaxing urgency and stopping pain). See how cleverly the formula was adjusted: the moment he recognized abdominal pain from dysentery, he swapped zhi mu for peony. And Chinese yam was exactly right for tonifying the spleen, so it took rice’s place.
💬 Note from Doctor Luo: By this point in his career, Doctor Zhang Xichun wielded this way of thinking with complete ease. For every herb in the formula — why it was there, why it was swapped — he knew precisely. That is the difference between a master physician and an ordinary one.
A big lesson: fu xie — the old heat illness hiding inside
This case led Doctor Zhang Xichun to an important insight. He said: whenever an illness shows no clear external pathogen, yet heat keeps sitting inside, it may well be a lurking pathogen (fu xie, 伏邪) — that is, heat from a febrile illness suffered long ago, which was never fully cleared at the time and has lain hidden in the body ever since.
How do you recognize it? Whenever the pulse genuinely shows heat, and repeated doses of cooling medicines do no good — or help briefly, then the illness promptly flares up again — that is the lurking pathogen at work. And what do you do?
💬 Note from Doctor Luo: Doctor Zhang Xichun’s answer: use raw gypsum in heavy doses to clear it — and if raw gypsum is combined with ginseng, the effect is even better. Once the external pathogen is cleared, it can no longer damage your health. This is Doctor Zhang Xichun writing down his own clinical experience and leaving it as a treasure for those who came after him.
Bonus: what do we learn today?
What do we learn from this case? Doctor Luo says: a great many “heat illnesses” are actually diarrhea caused by external pathogens hiding inside the body.
💬 Note from Doctor Luo: For example: last year you had an external illness and never treated it thoroughly, so the pathogen settled in and lurked — that’s fu xie (the lurking pathogen). If that lurking pathogen is heat, then raw gypsum plus ginseng can treat it — that’s Doctor Zhang Xichun’s approach. Ordinary folks might not dare to use it, but anyone studying Chinese medicine gains one more way of thinking about treatment. Doctor Zhang Xichun only wrote down what he had verified to work — this is the distilled experience of a predecessor, and we benefit by learning it.
That’s all for today. Tomorrow we continue with how Doctor Zhang Xichun used raw gypsum — we’ll get to the bottom of this herb. We don’t use raw gypsum much nowadays, but it truly is an excellent herb for clearing heat.
Compiled from Doctor Luo Dalun’s lectures on Doctor Zhang Xichun’s case records, from Medical Records Integrated Chinese and Western Medicine (《医学衷中参西录》).