Bloody Stool and Pain That Lingers After Every Bowel Movement? Imperial Physician Gong Tingxian’s Dysentery Case — Nine-Steamed Rhubarb (30 g), Cured in One Dose

Patient search terms: diarrhea with pus and blood / dysentery / stomach pain / rush to the toilet and it still hurts after / tenesmus / blood and pus in the stool

Medical terms for this condition: dysentery · damp-heat dysentery · damp-heat in the intestines · accumulated heat

Opening: the moment the prescription was written, the patient panicked

Today’s physician is the Ming dynasty’s Doctor Gong Tingxian — the “Number One Scholar of Medicine” (yi lin zhuang yuan), imperial physician of the Hanlin Medical Academy, the old master who lived to the age of 97 and cured no small number of strange illnesses for princes and princesses. Today’s patient is no small figure either — a high-ranking official. But the moment Doctor Gong Tingxian wrote the prescription, the patient panicked on the spot and flatly refused to drink it.

💬 Note from Doctor Luo: Before I begin this case, a quick warning — if you are in the middle of a meal, you may want to pause the audio. Today’s topic involves the intestines and upset stomachs, and this case opens with dysentery — pus, blood, and abdominal pain. It may turn your stomach a little, so feel free to step away.

Just how serious was this illness, that it could frighten an old man who had weathered storms of every kind?

Who was the patient? A Grand Minister of Justice, nearly seventy

The patient was Lord Liu, holding the office of Da Sikou — in ancient China, the highest official in charge of criminal justice and law, a man of enormous rank and power. This Lord Liu was nian jin gu xi — nearly seventy years old.

💬 Note from Doctor Luo: The ancients said, “From seventy on, life is rare” (ren sheng qi shi gu lai xi), so a man approaching seventy was called gu xi — “rare as the olden days.” A gentleman of that age, and the illness he caught was no light one — dysentery, and already severe: stools of pus and blood, which is very serious indeed; plus abdominal pain, and intense pain at that. Before this, quite a few doctors had been called, and they treated and treated — with no result at all.

The physicians were all at their wits’ end. Only then was Doctor Gong Tingxian summoned.

One touch of the pulse: your illness came from eating

Doctor Gong Tingxian felt the pulse: liu mai wei shu — the pulse was weak, yet beating fast in all six positions. The old master immediately understood.

💬 Note from Doctor Luo: Doctor Gong Tingxian said this was shi fei gan tai guo, nei you ji re — let me put that in plain words: you have been eating too well — far too well — and a mass of heat-toxin has built up in your intestines. Too much rich, fatty, heavy food, in excess, produces extreme heat inside the body. So where did this dysentery come from? It came from the table.

But before writing a single herb, Doctor Gong Tingxian first explained the whole method of treating dysentery — this old master always laid out the reasoning completely before treating.

Dysentery is not ordinary diarrhea: tenesmus, and pain after the stool

Using this case, Doctor Luo Dalun explained dysentery thoroughly. The ancients drew a sharp line between dysentery and an ordinary upset stomach:

💬 Note from Doctor Luo: Ordinary chronic diarrhea, an ordinary upset stomach — that is just diarrhea. Dysentery is diarrhea of the most violent kind. Its hallmark is called li ji hou zhong — tenesmus: the belly hurts terribly, and it is the kind of pain that lingers after you have gone — you rush to the toilet in an urgent hurry, but after the stool the pain remains, aching and miserable. And what comes out? Something like pus and blood, sometimes streaked red and white — a serious infection. Dysentery is a contagious disease; when you truly catch it, it is very serious. That is why hospitals today set up special intestinal-infection clinics every summer, devoted entirely to treating it.

So how should dysentery be treated? Doctor Gong Tingxian’s principle — and the very first sentence matters enormously.

First principle: no astringents at the start — drive the toxin out first

When dysentery first begins, many people’s instinctive reaction is: stop the diarrhea, fast. Doctor Gong Tingxian said: absolutely not.

💬 Note from Doctor Luo: Treating dysentery has its rules. At the very beginning, you must not use astringents — because inside there is heat-toxin; this is an intestinal infection. Herbs like Ying Su Ke (opium poppy husk) and He Zi (chebula fruit) — astringent herbs that stop leakage — should be avoided in the early stage. If you draw up and seal in, you may seem to have stopped the diarrhea, but you have trapped the toxin inside — and that is real trouble. So what must you do at the start? Push it out, clear it out — use detoxifying herbs and clear the damp-heat.

In dysentery the culprit is generally damp-heat. Red belongs to blood, white belongs to qi — red and white mixed, pus and blood falling together: all of it comes from the spleen and stomach losing their harmony, food stagnating, pent up between the stomach and intestines, transforming into damp-heat. That damp-heat toxin has to be driven outward — there is no other way.

💬 Note from Doctor Luo: Chinese medicine has two phrases — tong yin tong yong (treating a discharging illness with discharging methods) and se yin se yong (treating a blocked illness with tonifying methods). You have a draining illness (dysentery), but to expel the pathogenic evil I deliberately treat it with draining methods — that is tong yin tong yong. You have a blocked illness, and I tonify you — that is se yin se yong. In the first day or two of dysentery, when your upright qi (zheng qi) has not yet been depleted, you should dredge and drain. After three or four days, you cannot drain so fiercely anymore — a person who has run to the toilet that many times has lost yuan qi, and now clearing heat and resolving toxin plus regulating and nourishing the spleen and stomach become the main job. And further along still, you switch to supporting the upright qi.

The treatment formula: regulate the qi and the tenesmus resolves; move the blood and the pus heals

At this point Doctor Gong Tingxian — echoing the consensus of physicians across the ages — offered a two-line formula, and Doctor Luo Dalun marked it as the key point:

💬 Note from Doctor Luo: There is a saying about treating dysentery: xing xue ze bian nong zi yu, tiao qi ze hou zhong zi chu — “move the blood, and the pus in the stool heals by itself; regulate the qi, and the tenesmus resolves by itself.” Get the blood moving properly and the pus in your stool clears up on its own; get the qi flowing smoothly and that hou zhong — the pain that lingers after each bowel movement — disappears on its own. If the large intestine is stuffed full and blocked, causing tenesmus, then you should dredge and drain. If the large intestine’s qi is deficient and sinking and that causes tenesmus, then you must not purge — instead you lift and raise. With what? The Ren Shen Bai Du San (Ginseng Toxin-Resolving Powder) we discussed in an earlier case — this is the famous ni liu wan zhou fa — the “pull the boat back upstream” method. Ren Shen Bai Du San is commonly used for epidemics, and it appears in dysentery treatment too, because it disperses wind and clears heat, removes damp-heat, and tonifies the upright qi.

In the late stage of dysentery, when the pathogenic qi is gone and deficient upright qi has become the biggest problem — that is when you support the upright and astringe and secure.

The prescription: one herb — nine-steamed rhubarb, one liang (30 g)

The reasoning finished, the prescription appeared: nine-steamed rhubarb (jiu zheng da huang), one liang — one liang equals 30 grams. A single herb.

Everyone knows rhubarb (da huang), but the subtleties of this one herb, Doctor Gong Tingxian deployed with great care. Doctor Luo Dalun seized the chance to walk through the whole rhubarb family:

💬 Note from Doctor Luo: Rhubarb is a cold herb; it can clear heat, remove heat-toxin, and purge downward. In detail: if you truly want a violent purge, use raw rhubarb (sheng da huang) — and note, rhubarb must be added late (hou xia); if you boil it too long, its purging power weakens and its heat-clearing, toxin-resolving power strengthens. Then there is wine-processed rhubarb (jiu zhi da huang) — stir-fried or soaked and dried in wine: the wine carries the medicinal nature upward, clearing heat in the upper burner, and it also opens the channels. Then there is nine-steamed rhubarb — steamed repeatedly with wine: its power to clear damp-heat and resolve heat-toxin is strong, because the wine has steamed it through, so the purging force is softened — gentler, not so violent — and it can also move blood and dissolve stasis. There is also charred rhubarb (da huang tan), which astringes, moves blood and stops bleeding; and vinegar-processed rhubarb (cu zhi da huang), which resolves food stagnation — when food accumulation blocks the middle and causes abdominal fullness and pain, or postpartum stasis, vinegar rhubarb dissolves it. In fact, the ancients had countless processing methods for rhubarb; every dynasty accumulated new uses — I could talk about it for a whole day and not finish.

Why did Doctor Gong Tingxian insist on nine-steamed rhubarb? Because what he wanted was not a violent purge — he wanted to transform damp-heat and resolve heat-toxin. Lord Liu had not been sick for a day or two; inside him there was not only stagnation but heat-toxin as well. One liang of nine-steamed rhubarb sweeps the damp-heat out through the intestines.

The setback: the old gentleman turned white at the words “30 grams of rhubarb”

The prescription was written, and Lord Liu nearly fainted on the spot.

💬 Note from Doctor Luo: Lord Liu was dizzy at the very idea. He said: “Wu shuai lao, kong bu neng” — “I am old and frail; I fear I cannot.” At my age, you want me to take 30 grams of rhubarb? I’ll be purged so hard I’ll be washed away — no, no. You must give me something tonic, something gentle. Look at how well I eat — gifts of supplements arrive at my door without stop; I should be taking tonics. My upright qi is deficient — you can see how I’ve been drained by this diarrhea — and still you give me rhubarb? How can that be right?

Doctor Gong Tingxian did not lose patience. Instead he san zai kuan shi — again and again he reassured and explained, patiently, over and over. He talked for a long while, and Lord Liu listened and began to see the sense of it: all right, then. Let’s try. And he drank it.

The result? Yi ri er yu — within one day, the illness was cured.

Lesson one: use the medicine the pattern calls for — official rank changes nothing

The case is over, but Doctor Luo Dalun says the most valuable thing in this case is Doctor Gong Tingxian’s courage and steadiness of judgment.

💬 Note from Doctor Luo: Chinese medicine has a saying — you shi zheng ze yong shi yao: when the pattern is present, use the medicine that pattern calls for. This little case looks simple, but imagine actually facing such a man — a top official, a leader, dysentery draining him this badly. Could you prescribe him 30 grams of rhubarb and cure him with one purge? I doubt most people could. Most people would bend toward power, bend toward his authority, and write him some tonic, something mild and inoffensive. Why could Doctor Gong Tingxian do it? Because in his practice it was always you shi zheng ze yong shi yao: you have this pattern, so I use this medicine. Whether you are an official, a Grand Minister of Justice — it has nothing to do with me. That is why all those princes came to him for treatment — if he had cared about such things, he could never have produced results like this.

But courage is not recklessness. Doctor Gong Tingxian had sound judgment behind his bold use of rhubarb:

💬 Note from Doctor Luo: First, consider the timing — if the illness is in its early stage, the pathogenic qi is strong but the upright qi is still present; you may attack once and turn the illness around. But if the illness has dragged on for twenty-odd days, lingering without healing, and the body has grown weak, then purging like this would be a disaster. Second, consider the upright qi — Doctor Gong Tingxian must have judged that this Lord Liu’s upright qi was still holding, or he would never have dared. And third, he had to be sure there really was damp-heat and stagnation inside — if the damp-heat is not cleared out, then no amount of tonics and nourishment afterward will do any good.

Lesson two: how to use rhubarb — the late Master Zhao Shaoqin’s master technique

Rhubarb is a miraculous herb when the dosage is judged well, and a catastrophe when it is not. Doctor Luo Dalun told a real modern example:

💬 Note from Doctor Luo: The late Master Zhao Shaoqin (kidney-disease specialist at Beijing University of Chinese Medicine) treated kidney patients — some of whom were constipated — and his prescriptions always carried rhubarb at the end. How did he use it? He would prescribe a certain amount, then tell the patient: increase it yourself, a little at a time — check today whether you moved your bowels; if not, add one more gram tomorrow; the moment your stool becomes normal, stop. Some patients really worked their way up to 30 grams and their stool was still dry — people differ, and the heat inside them differs. When there is genuine damp-heat and heat-toxin, using rhubarb is fine — that is exactly you shi zheng ze yong shi yao. But rhubarb cannot be taken long-term — if you write seven doses of rhubarb at 30 grams a day and drink it for a full week, that is ruin. Purge once, and when the serious illness is turned around, you switch to regulation — clearing heat and resolving toxin on one side, nourishing and regulating on the other. That is how it is done.

Sometimes even one dose goes too far — with a gravely ill patient, a little rhubarb can purge him until his qi cannot come up and he cannot even stand. So judging the measure — whether pathogenic excess or upright deficiency dominates, whether the illness is new or chronic — must be weighed precisely. In this case Doctor Gong Tingxian judged it perfectly: a single dose, the damp-heat was cleared from the body, and he recovered; from then on it was just porridge and gentle spleen-stomach regulation.

Bonus story: Doctor Zhu Danxi treated his classmate — tonify first, purge after

At this point Doctor Luo Dalun told a similar story — Doctor Zhu Danxi, treating his own classmate, whose approach was exactly the reverse:

💬 Note from Doctor Luo: Doctor Gong Tingxian carried forward the thinking of the earlier masters — Li Dongyuan, Zhu Danxi and the rest. When he treated a certain prince’s leg pain, knee pain and foot pain, he used Zhu Danxi’s thinking — Si Wu Tang (Four Substances Decoction) plus herbs to clear damp-heat. And Zhu Danxi once treated his classmate for — dysentery too. This classmate was drained beyond measure: pale face, unwilling to move, upright qi deficient. Zhu Danxi thought it over: purging this man would not work; he needed tonifying first. So he kept tonifying — until the classmate could bear it no longer and thought he was dying: diarrhea pouring out every day, lying in bed unable to rise, and the whole city was gossiping that Zhu Danxi had treated him to death. Then Zhu Danxi, seeing the upright qi had recovered somewhat, wrote a formula and purged — “whoosh” — and he was well. Both times the damp-heat toxin was flushed out in one go, and both men recovered. The difference? That classmate’s upright qi was deficient, so it was tonify first, purge after. This Lord Liu, though old, had strong upright qi — one purge was enough.

Ending: a single herb of rhubarb reveals the level of the physician

Doctor Luo Dalun closed with a sigh: it looks like nothing but a single herb — but anyone who can wield rhubarb well is already a physician of real skill. When the pattern calls for it, even an old man can be cured with rhubarb; and conversely, a young person may be young, yet if the illness is severe and long-standing, even one or two grams of rhubarb will be more than he can bear — that will not do either. This is the pattern-differentiation thinking of Chinese medicine: never reckless, never misused, the measure always weighed.

💬 Note from Doctor Luo: One everyday tip while we are here: if you just want to move your bowels, buying cooked rhubarb (shu da huang) at the pharmacy is enough — raw rhubarb you cannot control. If you must use it, take a small piece and soak it in water, watch whether you have a bowel movement; if not, add a little more; the moment it moves, stop. Wine-processed and cooked rhubarb are both far gentler than the raw herb. But most of the time, seek a doctor’s guidance. And for a man like Lord Liu, once recovered — the rich, fatty foods must not return to the table. His stomach and intestines were weak; eat that way again and damp-heat will be reborn, and illness will follow. Clear the damp-heat, let the spleen and stomach slowly recover, let the upright qi return — and that is health.

Compiled from Doctor Luo Dalun’s commentary on the medical cases of Doctor Gong Tingxian. Source: Wan Bing Hui Chun (《万病回春》 — The Return of Spring for Ten Thousand Diseases), by Doctor Gong Tingxian (Ming dynasty, published 1587).