Hiccups That Won’t Stop? Doctor Zhu Danxi Nourished the Spleen and Cleared Damp-Heat
Today’s patient was a “tyrant” — not the kind who robs on the highway, but the kind who ruled his own household. Whatever he said went; who in the family dared to disagree? Yet Doctor Luo Dalun says he has read this case again and again, and every time he finds it more interesting: can a tyrant like that possibly stay healthy?
💬 Note from Doctor Luo: I first read this case back in medical school, and even then I thought the character sketch was wonderfully true to life — there really are people like this, who flare up the moment anything at home displeases them. But a temper like that cannot end well for the body. The cause of the illness lay entirely within the man himself.
Who was the patient? Doctor Zhu Danxi opened with five characters
The gentleman’s name was Zhao Lidao, nearly fifty years old — in ancient times, nearly fifty already counted as advanced age. The first thing Doctor Zhu Danxi (朱丹溪) wrote about him was just five characters: “frail in constitution and given to anger” (质弱而多怒).
💬 Note from Doctor Luo: Isn’t it wonderful how Doctor Zhu Danxi wrote his case records? He didn’t begin with the disease — he began with the man. First, he looked at the constitution: was this a strong person or a weak one? This man was frail. Second, he looked at the character: this man lost his temper constantly. The moment I read those five characters, I understood: here is a person with blazing liver fire who is forever raging — how could his body hold up? And where does a hot-tempered person end up weak? In the spleen and stomach — the digestive system is always the first casualty.
Doctor Zhu Danxi took emotion extremely seriously. He analyzed a patient’s character before anything else — because hidden there is the root of the disease.
A July day in Jiangnan: one missed meal, one explosion of rage
Next, Doctor Zhu Danxi fixed the time: July. Does anyone know what July in the Jiangnan region of China is like? In the old days, before air conditioning, the heat could genuinely kill — you would douse yourself with cold water again and again and still be burning; everyone craved cold drinks. Mid-summer, with the heat and dampness at their peak.
💬 Note from Doctor Luo: Doctor Zhu Danxi pointed out the climate too — in heat like this, pause and think: what kind of trouble does it breed? Then came the crucial detail: “struck suddenly by great hunger” (大饥卒犯) — he was suddenly starving, desperately hungry, and immediately demanded food. But a meal can’t appear the instant you ask for it; it has to be cooked. The household couldn’t produce dinner on the spot, and he flew into a towering rage.
One meal not served on time, and the fire shot straight up. In one small detail, Doctor Zhu Danxi recorded the entire onset of the illness.
Two days later: diarrhea that hurt even after it was over
Two days after the rage, the “tyrant” came down with zhi xia (滞下) — a draining diarrhea, in fact dysentery. Why the name “zhi xia” (stagnant downward flow)? Because after each bowel movement the pain continued — tenesmus (里急后重), that nagging sense of never being completely empty.
💬 Note from Doctor Luo: Why does a burst of rage bring on diarrhea? Because gan mu heng ni ke pi tu — liver wood runs rampant and attacks spleen earth. When liver fire flares, it bullies the spleen and stomach. The spleen was already weak, the food had been bolted down in a hurry, and so it all poured out. And there’s another clue buried here: his “sudden great hunger” — being abruptly ravenous means there was heat in the spleen and stomach, a depleted kind of heat, so he suffered easy hunger with rapid digestion (xiao gu shan ji), always getting hungry. These case records are like detective work — every clue links up.
Treating himself: raw honey in cold water
After the dysentery set in, he acquired a new complaint — thirst, desperate thirst. There was heat inside; the heat drove downward, the diarrhea poured out, fluids were badly damaged — of course he was thirsty. He tried his own remedy: raw honey stirred into cold water, and drank that whenever thirsty.
💬 Note from Doctor Luo: As he drank it, the diarrhea seemed to ease a little. Why? Because he genuinely had heat — the cold drink pressed the heat down a notch; honey is sweet, which is good for the spleen and stomach, and it also has a soothing, relaxing effect. So he felt temporarily better. But the root of the illness was untouched, and in this way he let it drag on five to seven days before calling in Doctor Zhu Danxi.
Doctor Zhu Danxi takes the pulse: put the honey water aside
Doctor Zhu Danxi felt the pulse: the pulse was slightly large but not rapid (脉稍大不数).
💬 Note from Doctor Luo: A “rapid” pulse beats fast. A pulse that is large but not rapid means the heat is no longer so obvious — it isn’t racing, but the largeness hints at some deficiency. Doctor Zhu Danxi said: stop the honey water. Instead: simmer ginseng and atractylodes into a decoction, drink this ginseng-and-atractylodes soup whenever thirsty, and take Yi Yuan San (益元散, Benefit the Source Powder) with it.
What is Yi Yuan San? It is the same as Liu Yi San (六一散, Six-to-One Powder) — talc (hua shi) and honey-fried licorice (zhi gan cao) in a six-to-one ratio, hence the name; it is also called Tian Shui San (天水散). One formula, several names.
💬 Note from Doctor Luo: What did Doctor Zhu Danxi use Yi Yuan San for? To clear damp-heat and guide the heat out. Talc’s job is to carry heat out of the body through the urine, paired with licorice. Then why ginseng and atractylodes? In Doctor Zhu Danxi’s day the terminology differed from ours — he said ginseng and atractylodes “nourish yin,” but what he really meant was tonifying the spleen and stomach. We now say every day that ginseng and atractylodes tonify the spleen — correct, and that is exactly what Doctor Zhu Danxi meant: fill the spleen to fullness, and yin blood will be generated naturally. So the strategy was: ginseng and atractylodes tonify the spleen as the foundation, while Yi Yuan San clears damp-heat outward. The weather was scorching, summer heat and dampness intermingled, so his body was loaded with damp-heat; clear it gradually, let the spleen and stomach slowly recover, and the man could slowly heal.
Seven or eight days later: the diarrhea improved — but the hiccups began
After taking the medicine, the diarrhea gradually drew in. Yet seven or eight days later, something new appeared — he began to feel drowsy and exhausted, and he started hiccuping.
💬 Note from Doctor Luo: This case is actually the example Doctor Zhu Danxi used when lecturing on hiccups — e ni (呃逆) — so the hiccups are the main complaint. We’ve all had hiccups: a chill, heat, emotional shock, or eating something unsuitable can bring on a temporary bout. But some hiccups are no laughing matter — cerebrovascular problems, tumors, can also cause hiccups; in ancient times, patients in the final, critical stage of an illness would hiccup too, and that was a death sentence. What we ordinarily see are the temporary, stoppable kinds. Analyzed properly, hiccups can be cold or hot, deficient or excess.
How did Doctor Zhu Danxi judge this case? He said this man was deficient — the spleen and stomach were weak, there had been prolonged diarrhea, the emotions were unsettled, liver qi was running rampant, and qi was rushing upward, so he hiccuped. His diagnosis: “the diarrhea has lasted too long, and yin is depleted” (下之久而阴虚也) — the draining had gone on so long that upright qi was insufficient and yin blood was depleted. So he told the patient to hold the course: don’t change the prescription, just keep taking it, tonifying slowly, no hurry; and since the honey had felt soothing, add a little refined honey (lian mi) to the mix.
The family wanted aconite and ginger — Doctor Zhu Danxi firmly shook his head
Three days passed this way, and the hiccups still hadn’t stopped. Doubt crept in: was the prescription wrong? If it were right, shouldn’t he be better by now? By common sense, most hiccups come from cold — the usual advice would be to brew up something warming like fu zi (aconite) and gan jiang (dried ginger) to warm the yang and stop the hiccups.
💬 Note from Doctor Luo: It’s true — most hiccups are tied to insufficient yang: someone with a weak spleen and stomach drinks ice water or breathes in cold air and immediately starts hiccuping, and a cup of hot water stops it at once. So everyone, from general experience, wanted to warm his yang with dried ginger and aconite. But Doctor Zhu Danxi said, absolutely not! Because of the summer heat, this patient genuinely carried damp-heat inside — we are using Yi Yuan San precisely to clear the summer heat out. To pile on aconite and dried ginger now would be to treat in exactly the wrong direction! Don’t rush, he said; tonics act slowly. Ginseng and atractylodes build up bit by bit, yin blood is generated gradually, damp-heat clears gradually — “fu zi is not a yin-nourishing substance” (附子非补阴者); aconite is drying and hot, and used at this moment, “aconite means death” (附子必死) — it would stir up dryness and mania, and the man would be finished.
Doctor Zhu Danxi added a famous line: “In heat this extreme, drinking cold cannot turn into a cold pattern” (严暑如此，饮凉非寒) — don’t doubt the treatment, “give it time” (待以时日); in a few more days, when the medicine’s strength arrives, the illness will cure itself.
💬 Note from Doctor Luo: This kind of thinking became extremely common later in the Warm Disease school (wen bing xue pai) — they constantly saw patients killed by warming herbs. Think about it: in Jiangnan, in the July–August wet heat at its heaviest, people were being scorched and their fluids devastated — before air conditioning, you felt your skin might split open just breathing; you showered in cold water countless times a day, and at night many slept on bamboo mats out in the open. I once talked with a doctor in Jiangnan whose family had practiced medicine for generations; he mentioned that in those years people genuinely died of heatstroke on the road. In that environment, give someone aconite and he can’t take it — with heavy damp-heat inside, a watermelon would be more fitting; aconite is a real danger. The heat back then was beyond what we can imagine: walking on the road with no water, under a blazing sun, could literally kill you. That is why the Warm Disease school feared aconite so much — they were born in Jiangnan, and the local climate had everything to do with it.
Four more days: the hiccups stopped, the diarrhea healed
Half convinced, half doubtful, everyone let him keep taking the medicine. Four more days passed, and the hiccups stopped; the diarrhea healed completely. Counting the whole affair, the illness had taken half a month to cure.
💬 Note from Doctor Luo: Doctor Zhu Danxi wrote this case very simply, and the prescription was very simple too — ginseng and atractylodes decoction taken with Yi Yuan San. Later generations haven’t paid this approach much attention: one bout of diarrhea, one bout of hiccups, treated for half a month — isn’t that rather slow? But I think it is precisely in case records like this that there is something worth chewing on.
Why is this plain little formula the one most worth pondering?
Doctor Luo Dalun says the brilliance of this case is not in the formula — it is in the skill of reading a person.
💬 Note from Doctor Luo: If you only look at the diarrhea and the hiccups, you can’t see the man behind them. A person of this temperament will have all manner of illnesses sprout from his body. If someone wheeled such a patient in today — a man who pounds the table and jumps up because dinner wasn’t served the instant he wanted it — I would guarantee his blood sugar, his liver, his cerebral vessels, and his heart are all headed for trouble. What Doctor Zhu Danxi saw was the entire trajectory of this man’s body. Why were there no hiccups at the start? Because at first there was no strength — the qi couldn’t rise high enough. After two days of tonifying, the spleen and stomach had some power, and liver qi, riding minister fire (xiang huo), surged upward — hence the hiccups. This shows the body had many problems, and they had to be adjusted one by one.
Where is the core? Lift up the spleen and stomach. Bad emotions bully the spleen and stomach; conversely, when the spleen and stomach are strong, they can make liver wood settle down. When spleen earth is sufficient, liver wood calms, lung metal stays clear and tranquil, heart fire cannot run excess, and the body slowly recovers — this is the key to breaking the vicious cycle of “liver fire ever hotter, spleen and stomach ever weaker.”
💬 Note from Doctor Luo: Doctor Zhu Danxi was a master at explaining principles. According to a biography written by his friend, he treated patients with patient, earnest counsel — constantly teaching them how to adjust, discussing outlook on life and ethics; this was, in effect, psychotherapy. The hiccups and diarrhea were only the problems momentarily exposed; what truly needed adjusting were the spleen and stomach and the temperament. For a man like this, adjusting the digestion and the temper was the only way his body could return to the right track.
The ending: a tyrant’s temper buys no longevity
One meal gone wrong, a month of belly trouble, and then unstoppable hiccups on top of it — Doctor Luo Dalun says it was all the doing of a bad temperament.
💬 Note from Doctor Luo: In the northeast of China we often see old men like this — absolute rulers at home, tyrants within their own four walls. But watch closely: anyone whose temper burns at that level either ends up paralyzed by a stroke or leaves this world early. Longevity for such a person is basically impossible. When the emotions are that volatile, how can the body be well? So in studying this case, we may never master the exact treatment method — but if you see that character can produce a whole catalogue of physical illness, that lesson alone is enormous. In daily life, try not to be such a “tyrant.” When something goes wrong, rein the fire in first — when the spleen and stomach are strong and the temperament is steady, the body has a real chance to mend.
Arranged from Doctor Luo Dalun’s explanation of Doctor Zhu Danxi’s case records; the original case is from Ge Zhi Yu Lun (Extra Teachings), chapter on hiccups.