Abdominal Pain and Diarrhea After Anger?

People search for: stomach pain after anger / diarrhea whenever I get angry / stomach pain and diarrhea from anger / stomach pain with diarrhea / alternating hot and cold / cannot eat and feel like vomiting / chest pain from anger

The medical terms behind it: liver wood overacting on spleen earth · shao yang syndrome · liver qi stagnation · illness triggered by anger

The opening: one huge fit of anger, and the whole body fell apart

Today we continue with the case stories of Doctor Xue Lizhai (薛立斋), the Ming-dynasty imperial physician. Doctor Xue served as head of the Imperial Medical Institute (太医院), and his patients ranged from princes and nobles down to ordinary working people; later he resigned his post, returned home, and went on treating common folk. Today’s patient was from his official days — a prefect (a regional governor) surnamed Zhu, Zhu Yangshan by name.

💬 Note from Doctor Luo: The cause of this illness is written out plainly in the original case record, in just two characters: yin nu (因怒) — triggered by anger — he had one fit of rage. Don’t underestimate a single bout of anger. A great many physical problems start exactly this way, so this case is especially instructive for all of us ordinary people.

After the anger, a whole string of illnesses arrived at once

After Prefect Zhu lost his temper, illness came on fast — and it came as a whole string of problems:

First, abdominal pain — and right after the pain, gushing diarrhea. Then distension in both flanks — a swelling, bloated feeling along both sides of the ribs. Sometimes pain in the chest and breast area, aching inside the chest. Then alternating chills and fever — hot one moment, shivering the next. His urination also became sluggish and not free-flowing. He couldn’t eat — his appetite was completely gone. He also vomited phlegm, bringing up phlegm from the stomach. And finally his mind went cloudy — a heavy, drowsy head, unable to think clearly.

💬 Note from Doctor Luo: Look at this long chain of symptoms — it all adds up to one sentence: one fit of anger, and the liver and spleen both fell into chaos. Doctor Luo has often said that bad emotions cause a great many illnesses, and the ancients were fully aware of this long ago. Just recently, China Telecom invited him to give a lecture to 220,000 people specifically on the relationship between emotions and the body — this has been his lifelong theme; from the very first day he began teaching Chinese medicine, he has been talking about liver qi stagnation and how to harmonize the shao yang.

Doctor Xue’s judgment: liver wood overacting on spleen earth

How was the disease diagnosed? Doctor Xue cut through it in one sentence: “This is liver wood overacting on spleen earth” (此肝木乘脾土).

💬 Note from Doctor Luo: This disease mechanism matches many cases we’ve discussed before — when the emotions turn sour, liver qi stagnates; the liver belongs to wood, the spleen to earth, and wood naturally overcomes earth. When liver qi becomes bound up, it cannot stretch out freely, so it runs sideways and bullies the spleen earth. Once bullied, the spleen and stomach fall into chaos: abdominal pain, diarrhea, loss of appetite, phlegm coming up — all of it is the spleen earth being mistreated.

The prescription: Xiao Chai Hu Tang, with a few extra herbs

Once the mechanism was clear, the formula wrote itself: Xiao Chai Hu Tang (Minor Bupleurum Decoction).

What are the ingredients of Xiao Chai Hu Tang? Chai hu (bupleurum), huang qin (baical skullcap root), ban xia (pinellia), ren shen (ginseng), zhi gan cao (honey-fried licorice), sheng jiang (fresh ginger), and da zao (jujube dates) — just these seven. It is one of the great formulas of Zhang Zhongjing’s Shang Han Lun (Treatise on Cold Damage).

Doctor Xue added a few more herbs: zhi zi (gardenia fruit) to clear heart fire — because this illness was set off by fire, the anger had heated things up; huang lian (coptis) to clear heat — because with vomiting of phlegm, there was heat inside; fu ling (poria) to resolve dampness and chen pi (tangerine peel) to move qi; and a little pao jiang (dry-fried ginger) to warm things up and keep the formula from being too cold.

💬 Note from Doctor Luo: This is Doctor Xue’s skill at modifying a formula. Xiao Chai Hu Tang itself is already a harmonizer of cold and heat — huang qin clears heat, sheng jiang warms and disperses. Doctor Xue stretched that idea one step further: to clear heat he added zhi zi and huang lian; to warm yang he added pao jiang; to resolve dampness he paired fu ling with ban xia; to move qi he paired chen pi with ban xia. And what was the result? One dose cured it — a single bowl of medicine, and the whole illness was gone. Doctor Xue’s differentiation was precise, and the cure came in one dose — this case is a classic.

Zhang Zhongjing’s Xiao Chai Hu Tang: originally a formula for external contraction

Speaking of Xiao Chai Hu Tang, Doctor Luo took care to explain its full history.

💬 Note from Doctor Luo: Xiao Chai Hu Tang comes from Zhang Zhongjing’s Shang Han Lun and is the leading formula for shao yang syndrome. What did Zhang Zhongjing use it for in his day? For external contraction — when external pathogens invade and enter the shao yang stage, a characteristic set of symptoms appears. But later generations gradually discovered that these formulas adjust the whole body: not only do they work when external pathogens arrive — even without a cold, if your body enters the same state, you can still use them to rebalance. That is why the formulas of the Shang Han Lun came to be used widely for internal disorders, vastly expanding their range of application.

What are the manifestations of shao yang syndrome?

So what symptoms make up shao yang syndrome? Doctor Luo went through the classic passages one by one:

Bitter taste in the mouth — a bitter flavor that won’t go away; dry throat — the mouth and throat feel parched; dizziness (mu xuan) — a spinning, fuzzy head, exactly like Prefect Zhu’s “clouded mind,” unable to think clearly; reluctance to eat with a quiet, listless mood (mo mo bu yu yin shi) — no appetite, no desire for food, like his “inability to eat”; vexation with a tendency to vomit (xin fan xi ou) — inner restlessness, easy to irritate, easy to vomit — like his vomiting of phlegm; and acid regurgitation and belching, too, all signs of stomach qi rebelling upward — because when liver wood overacts on spleen earth, stomach qi that should descend gets shoved upward by liver qi; alternating chills and fever (wang lai han re) — hot one moment, cold the next; put on a coat and you’re hot, take it off and you’re cold — Prefect Zhu had this too, the “alternating chills and fever”; and fullness and discomfort in the chest and flanks (xiong xie ku man) — chest oppression, distending pain in the chest and ribs — like his “chest and breast pain” and “distension in both flanks.” There can also be insomnia, vivid dreaming, headaches, and more.

💬 Note from Doctor Luo: Look — Prefect Zhu’s symptoms basically complete the entire shao yang picture: distension in both flanks, abdominal pain, chest pain… But did he have an external contraction? No! Where did this illness come from? Liver qi stagnation — because of anger, the liver and gallbladder lost their balance, and the body fell into this bound-up state, which matched shao yang syndrome perfectly. What does that tell us? The digestive system and the emotions are in direct communication. When the emotions go wrong, the first system to take the hit is the digestive system.

The bupleurum family of formulas: the “home base” for emotional illness

Once the pattern matches shao yang syndrome, how do we treat it? The formulas Zhang Zhongjing left us are superb — the bupleurum family (chai hu lei fang): a whole set of formulas built on Xiao Chai Hu Tang, with additions and subtractions.

💬 Note from Doctor Luo: And which one do I use most often? Chai Hu Jia Long Gu Mu Li Tang (Bupleurum plus Dragon Bone and Oyster Shell Decoction) — I’ve introduced it many times, and I use it constantly to regulate the emotions. I estimate that for 70% of the people who come to see me, I prescribe this formula — simply because so many of today’s illnesses are caused by bad emotions, and the bupleurum family works especially well for them. And formulas like Chai Hu Jia Long Gu Mu Li Tang are all derived from Xiao Chai Hu Tang, so Xiao Chai Hu Tang is the foundation of foundations in this family.

Why is Xiao Chai Hu Tang such a classic?

Xiao Chai Hu Tang has only seven ingredients, but its construction is exquisitely refined:

Chai hu (bupleurum) — lifts the medicinal force and the qi mechanism upward, dispersing pathogens; ban xia (pinellia) — dries dampness, transforms phlegm, and sends the qi mechanism downward. One up, one down. Huang qin (baical skullcap root) — clears heat; sheng jiang (fresh ginger) — disperses pathogens and warms. Ren shen (ginseng) — supports the upright qi.

💬 Note from Doctor Luo: Look at this formula — there is upward and downward movement, cold and heat, clearing of pathogens and support of upright qi — with that kind of design, its applications are enormously broad. From the day Zhang Zhongjing established this formula down to the present, every single Chinese medicine practitioner has worked on Xiao Chai Hu Tang; it is the most classic of classic formulas.

Can you take Xiao Chai Hu Granules? Yes — but stop as soon as it works

Today Xiao Chai Hu Tang is available as a patent medicine — Xiao Chai Hu Granules (小柴胡颗粒). Most people buy them for colds: when shao yang symptoms appear — a touch of nausea, a bitter mouth, alternating chills and fever, dizziness — a dose helps, because the formula is essentially one that drives the pathogen outward.

💬 Note from Doctor Luo: But let me add a caution: if your emotions are off and shao yang symptoms appear, the patent Xiao Chai Hu Granules can be used too — only, you must remember: stop as soon as it works (zhong bing ji zhi)! The rule of treatment is: once you see results, stop the medicine. Japan already had a painful lesson: a pharmaceutical company owner proclaimed that anyone could take Xiao Chai Hu Tang, freely, in large amounts, that it was wonderfully good for the body — and so people took it year after year, and they developed problems. Because every medicine is a medicine; you cannot treat it like food or take it daily like a health supplement. What are the characteristics of the classical formulas (jing fang)? Their force is great: if they truly match the pattern, recovery comes immediately; if they don’t match, taking them can actually do harm. So the right approach is: stop when it works.

Why no spleen-tonifying this time? In acute illness treat the branch; in chronic illness treat the root

In the previous cases by Doctor Xue, most illnesses were spleen-stomach weakness caused by chronic emotions — liver wood overacting on spleen earth — and his strategy was to tonify the spleen earth: build the spleen up until the liver wood gradually settles and returns to its proper track. So why this time did he go straight for the liver wood and harmonize the shao yang, instead of tonifying the spleen and stomach?

💬 Note from Doctor Luo: In the collected annotations to Doctor Xue’s case records there is a passage devoted to exactly this — there is a difference between an acute onset and a gradual one. The earlier patients had long-term, chronic emotional suppression — pent-up, depressed feelings that gradually weakened the spleen and stomach, a chronic condition that must be treated by slowly tonifying the spleen, building the spleen-stomach qi back up bit by bit until the trend reverses. This case is different: the prefect’s anger came suddenly, and the onset was acute. The spleen earth was harmed here too, to be sure, but liver qi stagnation was the principal contradiction — so the urgent task was to harmonize the shao yang, to regulate the liver and gallbladder, to open up the liver qi and disperse the qi mechanism. That is what the classics call “in acute illness treat the branch; in chronic illness treat the root” (急则治其标，缓则治其本).

There is one more point worth noting: those earlier chronic patients, depressed for years, had faces that had changed color — yellow tinged with green and so on, the color of an organ slowly leaking out over time. Prefect Zhu, by contrast, got angry suddenly, with an acute onset — his complexion may not have changed at all noticeably; a red face from rage was possible. That is why Doctor Xue never even recorded his complexion in this case — it was not a color that had seeped out over years, so writing it down would have had no diagnostic meaning. Put the earlier and later cases side by side, and you can see that Doctor Xue indeed distinguished “acute — treat the branch; chronic — treat the root” — and this is precisely what we need to learn.

💬 Note from Doctor Luo: So remember just one idea: shao yang syndrome and what we today call liver qi stagnation — the bodily changes caused by bad emotions — share essentially the same mechanism: all of them can be regulated with the bupleurum family of formulas. The Chai Hu Jia Long Gu Mu Li Tang that I introduce every day is just one member of that family. These classic formulas of Doctor Xue — if you truly learn them, they will surely help you.

Organized from Doctor Luo Dalun’s commentary on Doctor Xue Lizhai’s case records; the original case comes from Xue’s Case Records (《薛氏医案》).