Chronic Diarrhea That Won’t Heal, and It Still Hurts Afterward?

What people search for: chronic diarrhea / diarrhea that won’t heal / stomach still hurts after diarrhea / belly hurts badly / long-standing diarrhea / diarrhea after catching a chill / dried ginger water can’t stop it

In medical terms: zhixia (dysentery-type disorder) · blood stasis obstructing the interior · constrained liver qi · spleen deficiency with dampness

Opening: first, learn four characters — “feng yang hou zhe” (well provided for)

Doctor Luo Dalun tells the story of Doctor Zhu Danxi at work. Today’s patient appears in the case record with four characters written right at the start: feng yang hou zhe (奉养厚者). Doctor Zhu Danxi never wasted words — those four opening characters are the key to the entire case.

💬 Note from Doctor Luo: “Feng yang hou zhe” means a person whose salary was extremely high, whose treatment was extremely good. In that era, a merchant who got rich was not called feng yang hou — only an official who had risen to a high rank and enjoyed a generous stipend earned that label. With those four characters, Doctor Zhu Danxi immediately gave us two judgments. First, such a man dines on delicacies every day and never stops socializing — he eats exceptionally well, and his spleen and stomach were wounded long ago. As the classics say, “when food and drink are doubled, the spleen and stomach are injured” — eat too much, eat too richly, and the spleen and stomach cannot carry the load; the one who overeats is actually the most deficient. Second, officials worry a great deal and carry heavy responsibility — worrying harms the spleen — and with worries and pressure pent up inside, there is also constrained liver qi (gan qi bu shu). So when an old-school doctor asks what you do for a living, he is not making small talk — he is gathering information. Analyzing a person’s illness is exactly like cracking a case.

Who was the patient: a vigorous official in his thirties

The patient was an official in his thirties, in the prime of life — yet with a robust constitution, he was knocked flat by this illness and suffered for eight full days without improvement.

What was the disease? In late summer and early autumn, just as the weather turned cool, he began to have diarrhea: his belly hurt, and after a movement the pain continued, with a constant urge to run to the toilet — what Chinese medicine calls zhixia (滞下), the dysentery-type disorder in which elimination is never clean or easy. And the pain was severe: fu da tong — his belly hurt terribly, terribly badly.

Playing doctor on himself: three jin of dried ginger water in eight days

What do you do when illness strikes? Someone offered advice: you must have caught a chill — just boil dried ginger water and drink it. The patient tried it. Ah — one cup and the belly pain stopped. But before long the pain returned; he drank more ginger water to suppress it, and a while later it hurt again…

Back and forth he went, and over the course of a few days he consumed three jin of dried ginger (fu ganjiang zhi san jin) — three jin of dried ginger! And still the disease did not improve. After eight days, at his wit’s end, he finally came to see Doctor Zhu Danxi.

💬 Note from Doctor Luo: It stopped hurting when he drank, and hurt again when he didn’t — what does that tell you? There was a pathogenic factor lodged in the belly, and warming dried ginger could only suppress it temporarily; the root cause had not been touched at all. Worse, three jin of dried ginger had drained his yin blood — dried ginger in large amounts damages yin blood, and since the liver stores the blood, this is all the worse for someone with constrained liver qi. This is the lesson of “treating illness without understanding pattern differentiation, drinking medicine like water.”

The diagnostic highlight: one touch of the pulse, and Doctor Zhu Danxi understood everything

Doctor Zhu Danxi felt the pulse:

• Left pulse wiry, slightly large and firm (xian er shao da shi) — a wiry pulse indicates constrained liver qi; the left position reflects the heart, liver, and kidneys, so a wiry left pulse means liver qi is markedly constrained (the ancients spoke of “the liver pulse alone being large” — touch the liver position and it feels especially big, bulging there like a bean);
• Right pulse also wiry — the right pulse is wiry too, which means liver Wood is running amok and bullying the Spleen Earth (gan mu heng ni ke pi tu) — the liver is oppressing the spleen;
• Tight at the middle position (zhong qu zhi jin) — press to the middle level and the pulse is tight, indicating blood stasis inside.

Doctor Zhu Danxi judged at once: “This must have come from drinking to excess, eating one’s fill, and then taking too much cold food.” — You must have gotten drunk, eaten your fill, and then consumed too many icy things.

💬 Note from Doctor Luo: The cause splits into two layers. First, after a bout of drunken feasting, the yang qi is wounded. Second — and this is the most important — after heavy eating and drinking, the spleen and stomach’s function is already low; the food and wine cannot be transformed and transported, and if you then add cold, the cold congeals and stagnates, and blood stasis forms. A great deal of spleen-stomach blood stasis originates exactly this way. So Doctor Zhu Danxi concluded that the disease should be treated as deficiency-cold (dang zuo xu han lai zhi) — note that the classical phrase “dang zuo” here means “ought to be treated as,” it is the doctor’s own judgment, not the modern colloquial sense of “mistakenly treated as.” The punctuation and parsing of this sentence have been debated for centuries, and Doctor Luo Dalun has specifically discussed the point.

The prescription, broken down: Si Wu Tang as the base, and in come Peach Kernel and Safflower

When Doctor Zhu Danxi wrote the formula, the whole approach rose a level — it was no longer merely warming the yang. He knew the patient had already taken enormous amounts of dried ginger, so the warming strategy had been used to the full; that is why his formula contains no dried ginger (too drying) — instead he used fresh ginger juice (shengjiang zhi), added after the decoction was finished.

The body of the formula is Four Substances Decoction (Si Wu Tang) minus Dihuang: Danggui (Chinese angelica), Baishao (white peony), and Chuanxiong (ligusticum) — these three nourish the liver blood and soften the liver. Why drop Dihuang? Dihuang is too cloying and sticky; with a weak spleen and heavy phlegm-food stagnation, it cannot be used.

To that he added Renshen (ginseng), Baizhu (white atractylodes), and Fuling (poria) — essentially Four Gentlemen Decoction (Si Jun Zi Tang) minus Gancao, tonifying the spleen and the qi. Almost every formula Doctor Zhu Danxi wrote contains Renshen and Baizhu — tonifying the spleen and qi was what he valued most.

Then one herb of Chenpi (tangerine peel) — to regulate and move the qi. All tonics — if they go in and just clog things up, what then? A little Chenpi keeps the tonification from stagnating. This is Doctor Zhu Danxi’s classic move.

The most important additions are the last two: wine-fried Honghua (safflower) and Taoren (peach kernel) — to invigorate the blood and resolve stasis!

💬 Note from Doctor Luo: Taoren and Honghua are the classic stasis-resolving pair: Taoren disperses the formed, substantial blood stasis; Honghua is especially good at dispersing the unformed, newly formed, fine-grained stasis. Doctor Zhu Danxi was particularly skilled at putting Si Wu Tang together with Taoren and Honghua — the formula Tao Hong Si Wu Tang comes from right here in Doctor Zhu Danxi’s practice! If you want to find this formula’s founding ancestor, flip to Doctor Zhu Danxi’s case records and there it is. His logic: I nourish your blood first, because if you only resolve stasis, and there is no blood in the pipes, what stasis are you resolving? It is like a pipe clogged with silt and garbage but with no water running through it — how exhausting to go at it with a knife! Turn on the water, and the silt washes away. Resolving stasis on a foundation of nourished blood works best.

Why resolve stasis at all: the root of a diarrhea that never heals is that mass of stagnant blood

Why did this illness fail to improve after eight days of diarrhea and three jin of dried ginger? Doctor Luo Dalun says: the root is blood stasis.

The patient ordinarily ate very well, so his phlegm-damp was heavy to begin with; after drunken feasting he took cold food, and blood stasis formed; then he force-fed himself three jin of dried ginger, which drained his yin blood — phlegm, dampness, and stagnant blood congealed together, and so the diarrhea could never be completely expelled. He always felt there was more to come, and the pain was extraordinary.

💬 Note from Doctor Luo: In this kind of complex illness, blood stasis is often hidden inside, and ordinary people cannot see it. You decide he caught a chill and warm the yang; dried ginger presses it down for a while — but the stagnant blood is still blocking the way, so of course the belly keeps hurting. Doctor Zhu Danxi learned this move from Zhang Zhongjing — Zhang Zhongjing’s Taohe Chengqi Decoction (Peach Kernel Qi-Guiding Decoction) is exactly this: purging plus invigorating blood and resolving stasis, so the stagnant blood is broken up and expelled, and only then can qi and blood move freely. Doctor Zhu Danxi’s teacher, Doctor Luo Zhiti (罗知悌), once treated a thin, wasted monk by first simmering pork stomach until it was utterly soft and feeding it to him, building up his qi — and only then giving him Taohe Chengqi Decoction to purge out the stagnant blood and phlegm accumulation. The monk recovered. Doctor Zhu Danxi inherited this whole system and made it his signature method for miscellaneous diseases. Once the stasis resolved, the belly no longer hurt so badly.

The result: drink it slowly, and in one month he was well

How was the formula to be taken? Doctor Zhu Danxi instructed: drink it slowly, do not rush. And so — fu yi yue er an — after one month of taking it, the illness was cured, and he had grown noticeably sturdier, restored to his original condition.

💬 Note from Doctor Luo: Some friends will ask: for a little diarrhea, why a whole month? The defining trait of Doctor Zhu Danxi’s treatment is that he treated the person, not the disease. Adjust the whole person, and the symptoms naturally disappear. And do not look down on chronic diarrhea — today, patients who drift from hospital to hospital for years without a cure are everywhere; some conditions, like ulcerative colitis, have even been classified by international medical organizations as diseases that are difficult to cure. So Doctor Zhu Danxi was in no hurry — he adjusted things bit by bit, because restoring the body is the true cure.

Note from the commentator: for emotion-driven diarrhea, the strategy is “restrain Wood and support Earth”

Doctor Luo Dalun summarizes the three lessons of this case:

First, bad emotions will always produce digestive problems. Liver Wood runs amok and oppresses Spleen Earth; in Western terms, the digestive tract contains hundreds of millions of neurons that register emotion, and negative emotions disturb the rhythm of intestinal movement — so chronic colitis and ulcerative colitis, strictly speaking, are related to emotions. The liver channel also passes through the abdomen; this is the theoretical foundation for Doctor Zhu Danxi’s attention to the emotions.

Second, the strategy for emotion-driven diarrhea: restrain Wood and support Earth (yi mu fu tu). On the one hand, tonify the spleen and qi, so that Earth grows strong and cannot be bullied by Wood; on the other hand, nourish the liver blood and soften the liver, so that Wood is not so violent. Ba Zhen Tang (Eight Treasures Decoction) is the model of this approach — Si Jun Zi Tang tonifies the spleen and qi, Si Wu Tang nourishes the blood and softens the liver; together they are both “tonify qi and blood” and “strengthen Spleen Earth, benefit Liver Wood.” Doctor Zhu Danxi used this pattern extensively. For moving qi he used only one herb, Chenpi; today we could add Yujin (curcuma) and Yuanzhi (polygala), while Doctor Zhang Xichun liked to add Sheng Maiya (raw malt).

Third, the greatest feature of Doctor Zhu Danxi’s treatment: support the upright qi. Look at this formula: for stasis there are only two herbs, Taoren and Honghua; one herb for moving qi, Chenpi; one herb for draining dampness, Fuling — everything else supports the upright qi. The priorities are perfectly clear. If a person’s upright qi is deficient and you only resolve phlegm, resolve stasis, and untie depression, you have put the cart before the horse.

💬 Note from Doctor Luo: In closing, let me say a fair word for Doctor Zhu Danxi. Many Chinese-medicine enthusiasts today call him the “yin-nourishing school,” claim he destroyed yang qi with endless harm, some even shout “an eternal sinner” — I truly feel wronged on his behalf. Go open Doctor Zhu Danxi’s books: when he treated consumptive lung disease (tuberculosis), his formulas contain both yin-nourishing and yang-warming herbs — Ganjiang and Renshen are listed plainly. He used yin-nourishing only when he encountered a yin-deficiency pattern. He treated whatever pattern presented itself with whatever medicine fit — he was not “I am of the yin-nourishing school, therefore I nourish yin and nothing else.” The people who say otherwise have probably never even opened his books; they repeat what they have heard by ear. The true physician is never governed by school labels.

Bonus: the “family register” of this formula

One last, delightful piece of knowledge: Tao Hong Si Wu Tang, the famous formula of later generations, has its origin right here with Doctor Zhu Danxi — Si Wu Tang plus Taoren and Honghua. If you want to find this formula’s “founding ancestor,” flip to Doctor Zhu Danxi’s case records and there he is. Doctor Zhu Danxi took Zhang Zhongjing’s emphasis on resolving stasis and transformed it into the blood-nourishing, stasis-resolving Tao Hong Si Wu Tang; later generations of gynecologists and internal-medicine doctors used it as the base for resolving stasis and regulating menstruation.

Compiled from Doctor Luo Dalun’s explanations of Doctor Zhu Danxi’s case records; the cases come from the Danxi Xin Fa series.