Diarrhea When Angry or Depressed? Doctor Xue Lizhai Sees Spleen Qi Sinking and Cures It With Liujunzi Tang (Six Gentlemen Decoction) Plus Sishen Wan (Four Spirits Pill) to Warm Yang and Tonify the Spleen
Patient’s search terms: diarrhea when angry / stomach upset when depressed / diarrhea when emotions are off / diarrhea after getting angry following a meal / belly still hurts after passing stool
Medical terms: liver wood sinking and constrained · spleen qi sinking · diarrhea from repressed anger · liver qi invading the spleen · emotional diarrhea (irritable bowel syndrome)
Opening: she finished her meal, flew into a rage, and ended up with dysentery-like diarrhea
Today’s story begins with a meal. Doctor Luo Dalun often says that if you mishandle the moments before and after eating, you can make yourself ill — and here is one way it happens: you finish dinner, then you get angry. The anger surges up, and the next thing you know, your gut is in open revolt.
💬 Note from Doctor Luo: This elderly woman got angry right after a meal and developed diarrhea that looked just like dysentery, complete with tenesmus (li ji hou zhong). But this was not true dysentery — real dysentery is an infectious disease of the gut. What she had was diarrhea that resembles dysentery: her belly ached, and it still ached after she passed stool. Diarrhea brought on by bad emotions is extraordinarily common in daily life.
Who was the patient: an elderly woman, angry after a meal, with abdominal pain and endless diarrhea
The patient was an elderly woman. One day, after finishing her meal, she became angry for some reason — in Chinese medicine this is called hui nu (pent-up wrath). Anger injures the liver, and the liver qi turns sideways and runs rampant. The old lady’s belly immediately refused to cooperate: diarrhea poured out of her, she ran to the toilet many times a day, and this was not the ordinary “relief after passing” kind of diarrhea. It was tenesmus: her belly ached, she felt the urge to go but could not pass comfortably, and after she finally passed stool, the belly still hurt.
💬 Note from Doctor Luo: There is nothing strange about this illness. Think about it — some children get diarrhea right before every exam: midterms, finals, same story every time. Why? Nervousness and anxiety. When the emotions change, the digestive system changes along with them. I have said before that the digestive tract contains hundreds of millions of neurons, and they listen only to the emotions — not to the brain’s commands. You can order your intestines to “hurry up and move,” and they will ignore you. But the moment your emotions shift, their peristalsis changes immediately. Modern medicine calls this the abdominal brain — there is a kind of “brain” down in the belly, and it is quite influential: it perceives emotions and interacts with them.
Two kinds of anger: one explodes outward, one is swallowed back down
Anger is not one single thing — there is anger and there is anger. Doctor Luo Dalun divides anger into two types, and the treatments are completely different.
💬 Note from Doctor Luo: One type is explosive anger (bao nu) — the fire bursts out on the spot. People of this type usually have strong yang, yin deficiency with fire, and a tendency toward liver fire. When explosive anger leads to diarrhea, you soothe the liver and move the qi — and you also clear a bit of heat. The other type is repressed anger (yu nu) — the person’s yang qi was never strong to begin with. When they get angry, the anger cannot come out; it is swallowed and bottled up in the belly. This kind of anger moves downward: the liver qi becomes constrained, the liver qi turns sideways and attacks the spleen earth, yang qi is insufficient, the qi mechanism sinks, and diarrhea arrives. One is a yang pattern, the other a yin pattern — the directions are exactly opposite.
The diagnostic high point: Doctor Xue Lizhai sees it at a glance — spleen qi sinking
With a patient like this, most physicians would have reached for “constrained liver qi” and treated her by soothing the liver and moving the qi. Doctor Xue Lizhai, however, fixed on one word from the very start: deficiency.
💬 Note from Doctor Luo: Doctor Xue Lizhai said this was spleen qi sinking (pi qi xia xian) — her spleen qi had always been weak and unable to rise, and her yang qi was insufficient to boot. When this bout of repressed anger bottled everything up, it pushed the qi mechanism downward, and the spleen earth was crushed. The most important thing here is that we must not keep only one strategy — “soothe the liver, move the qi” — in our heads. Zhang Zhongjing said it long ago: “When you see a disease of the liver, know that the liver transmits to the spleen, and must first strengthen the spleen.” When the liver qi turns sideways to bully the spleen earth, if you prop the spleen earth up and fill it full, the liver qi can no longer run rampant, and the disharmony of the liver channel can reverse itself. This is exactly where Doctor Xue Lizhai’s brilliance lies.
Anatomy of the prescription: Liujunzi Tang as the base, combined with Sishen Wan to warm yang and tonify the spleen
Once the direction was set, the formula followed naturally: a large dose of Liujunzi Tang (Six Gentlemen Decoction), plus fu zi (aconite) and rou dou kou (nutmeg), with mu xiang (costus root) 1 qian (~3 g), wu zhu yu (evodia fruit) 5 fen (~1.5 g), and bu gu zhi (psoralea fruit) and wu wei zi (schisandra fruit) 1.5 qian each (~4.5 g).
💬 Note from Doctor Luo: Everyone knows Liujunzi Tang — it is Sijunzi Tang (Four Gentlemen Decoction) — ren shen (ginseng), bai zhu (atractylodes), fu ling (poria), and gan cao (licorice) — plus chen pi (tangerine peel) and ban xia (pinellia). It is the ancestral formula for tonifying qi and strengthening the spleen. Within it, the Four Gentlemen tonify qi, fu zi warms yang, and rou dou kou warms the middle. Adding wu zhu yu, bu gu zhi, and wu wei zi makes it, in effect, the Sishen Wan (Four Spirits Pill) route — warming the kidneys and the spleen, securing the intestines, and stopping diarrhea. Mu xiang is added to move the qi. Why prescribe it this way? Because the root problem is insufficient yang and exuberant internal cold. When you prop up the spleen earth and warm the yang qi, the liver qi loses the strength to run sideways. Strengthening the upright qi is the key at this moment.
Setback one: the diarrhea retreated, but the lower belly still felt bloated — lift the qi upward
Two doses in, the effect was immediate: the severe diarrhea completely stopped. But the old lady still had a leftover complaint — lower abdominal distension, a constant bloated feeling.
💬 Note from Doctor Luo: Doctor Xue Lizhai said, “This is liver qi stagnating in the spleen” — the spleen earth had been replenished, but the constrained liver qi had not yet fully opened up. The liver channel happens to run through the lower abdomen. With liver wood sinking and constrained, the qi was stuck there, and so the lower belly swelled. At this point Doctor Xue Lizhai switched to Tiaozhong Yiqi Tang (Regulate the Middle and Augment Qi Decoction), adding fu zi (aconite) and mu xiang (costus root), 5 fen each. Tiaozhong Yiqi Tang is very close to Buzhong Yiqi Tang: huang qi (astragalus) and ren shen (ginseng) form the base, chai hu (bupleurum) and sheng ma (bugbane root) lift the qi upward, and mu xiang and chen pi move the qi, with a little cang zhu (black atractylodes) to dry dampness — tonify the upright qi on one hand, lift the sinking qi upward on the other, and gently soothe the liver as well. Mu xiang was added in only 5 fen — a very small amount. The big picture had already turned around; a small nudge to move the qi was all that was needed.
Setback two: why does my mouth taste salty? — two doses of Liuwei Dihuang Wan close the case
The lower abdominal distension resolved too. Just as the case seemed finished, the old lady reported one more odd symptom: a salty taste in her mouth.
💬 Note from Doctor Luo: A salty taste in the mouth is a sign of kidney-channel disharmony — salt is the flavor of the kidney, and when an internal organ is out of balance, it can show up in the mouth. Kidney-channel disharmony comes in two varieties: kidney yang deficiency, treated with Jingui Shenqi Wan (Golden Cabinet Kidney Qi Pill, the Eight-Flavor Pill); and kidney yin deficiency, treated with Liuwei Dihuang Wan (Six Flavor Rehmannia Pill). Doctor Xue Lizhai chose Liuwei Dihuang Wan here — because the earlier warming herbs, the fu zi and the Four Spirits Pill, had been used fairly heavily and tipped things slightly past the mark. She had been deficient in both yin and yang from the start; once the yang was built back up, the yin-deficient side surfaced. Liuwei Dihuang Wan nourishes yin, and after just two doses, the illness was completely cured.
Commentator’s note: three consultations, three formula changes, a one-week cure
Count them up: Doctor Xue Lizhai adjusted the prescription three times, using only one or two doses at each step, and had the old lady completely cured within a week.
💬 Note from Doctor Luo: The hardest part of this case is the very beginning. The patient comes in with gushing diarrhea and tenesmus — you may not immediately judge whether it is cold or heat, or where to start. Doctor Xue Lizhai recognized yang deficiency right away and went straight to tonifying the spleen. That diagnosis is extremely difficult. He left behind more than three thousand case records and treated emperors. Why could he cure patients in just a few doses? Because his diagnoses were astonishingly accurate — he struck the vital point on the first move: warm the yang, let the body develop toward the yang direction; tonify the spleen, fill the spleen qi full; then add a little qi-moving, qi-regulating medicine to lift the qi. That kind of thinking is remarkably precise.
A personal story as a bonus: Doctor Luo Dalun’s own “grief diarrhea”
After telling this case, Doctor Luo Dalun shared a personal experience — not a case record, yet better than one.
💬 Note from Doctor Luo: My father passed away the year before last. I was away on a business trip at the time and could not get back in time. I felt terribly guilty — I kept thinking that if I had been by his side, maybe the ending would have been different. After the funeral, I came down with diarrhea that lasted a month or two. My heart was so heavy that I did not even prescribe medicine for myself; I felt this was heaven’s punishment for me. But that experience taught me profoundly: low spirits really do cause real problems in the digestive system. Explosive anger is yang in nature and moves upward; but the low, repressed, sorrowful emotions — grief — are yin in nature and move downward: the liver wood sinks and becomes constrained, the qi mechanism drains downward, and diarrhea follows. This kind of diarrhea can be severe. Later I read the Qing-dynasty physician Huang Yuanyu and others; when they met this situation they also warmed yang, regulated the qi, and lifted it upward — exactly the same route as Doctor Xue Lizhai. The ancients analyzed this matter very clearly.
Closing note: tonify the spleen and warm the yang to reverse the whole picture
With the case finished, Doctor Luo Dalun left a final passage worth pondering again and again.
💬 Note from Doctor Luo: These days, most of us do not get many chances to explode in fury. What we have more of is gloom and low spirits. If this kind of emotion causes digestive problems, how do we regulate it? Doctor Xue Lizhai pointed the way: tonify the spleen — and if you feel yang deficiency, warm the yang a little as well — to turn the whole situation around. Then add a small amount of qi-moving, liver-soothing herbs; just a little, as you can see — he used only 5 fen of mu xiang. The big picture is what matters most: if the spleen qi is still that weak and the yang qi still that insufficient, then any bad emotion at all becomes the last straw that breaks the camel’s back. Prop up the spleen and stomach, warm the yang qi, and the body will naturally stop being knocked over by the emotions.
Compiled from Doctor Luo Dalun’s lecture explaining the case records of Doctor Xue Lizhai; the case is from Xue’s Case Records (《薛氏医案》).