Diarrhea for Months, a Dozen Times a Day, a Swollen Face? Here’s What to Do
What people search for: diarrhea that never clears / dysentery / chronic diarrhea / running to the toilet a dozen times a day / diarrhea so bad the face swells
Medical terms for this case: xiu xi li (recurrent or “resting” dysentery) · chronic dysentery · yang pathogen sinking into the yin layer
Opening: a 73-year-old man who spent an entire autumn running to the toilet
In the late Ming and early Qing dynasties, the great physician Doctor Yu Jiayan (喻嘉言) left behind a case that holds a special place in the history of Chinese medicine. Students of Chinese medicine may never have heard of this particular patient, but almost everyone has heard of the method that came out of it — the famous “reversing the boat against the current” method (ni liu wan zhou fa), which was born from exactly this case.
💬 Note from Doctor Luo: Doctor Yu Jiayan raised this method with just a handful of words, yet those words represent an entire way of thinking that generations of physicians have kept studying ever since. Today’s story begins with the old man in his account.
The patient was Zhou Xinchuan (周信川), 73 years old. Doctor Yu, when he wrote up the case, put the age down first — that is his clue to the reader: at 73, although the old man was ordinarily sturdy and did not feel his age, the years were there, and his upright qi (zheng qi) had already begun to ebb. He was not the same as a young man.
Dysentery in autumn, dragged into winter — and became “recurrent dysentery”
That autumn, Zhou Xinchuan caught dysentery, and it never cleared up. Dragged on into winter, it became what Chinese medicine calls xiu xi li — “recurrent dysentery” or “resting dysentery.” What does that mean? It means coming and going, lingering without end: better for a while, then flaring up again, never quite breaking the cycle.
💬 Note from Doctor Luo: “Xiu xi li” is a Chinese medical term — in plain words, chronic dysentery, chronic diarrhea. Keep this name in mind; all the cleverness of this case hangs on it.
By now the symptoms were severe: he was running to the toilet more than ten times in a day and night, with no rest at all. Even more alarming — his face began to swell, and his skin turned dull and dark. How can diarrhea make your face swell? It tells you that the upright qi is seriously depleted and the spleen is deficient with heavy dampness — the dampness is so heavy that the whole body is in trouble. The dark, lusterless skin is an even stronger signal of qi deficiency pushed to the extreme.
The pulse: Doctor Yu Jiayan pronounces one key diagnostic sentence
Zhou Xinchuan came to Doctor Yu for help. The moment he felt the pulse: deep (chen), rapid (shu), and forceful — not a pulse floating on the surface, but one sunk deep inside.
Doctor Yu Jiayan said: “This is the case of yang pathogen sinking into the yin layer (yang xie xian yu yin).”
💬 Note from Doctor Luo: This sentence is the master switch for understanding the whole case. It means: this pathogen originally belonged to the yang layer (the surface, the exterior), but because the upright qi was insufficient and had no strength to resist, the pathogen burrowed deeper and deeper until it sank into the yin layer (the interior). That is why the pulse is deep, rapid and forceful — there is pathogen sitting inside.
The pathogen has sunk deep inside, and yet the man keeps leaking it out through diarrhea day after day — how do you treat that? Doctor Yu was not flustered at all. He said: “I have my own method of treatment; this can be cured.” A 73-year-old man leaking like this was no joke, but — don’t worry — “tomorrow I will bring the medicine myself and treat you face to face.”
The strange treatment: Renshen Baidu San + sitting over a brazier + blocking the anus
The next day, Doctor Yu arrived with the medicine. The formula he used was Renshen Baidu San in its original form — the original decoction, and on top of that he ground the herbs into coarse granules and boiled them again, so the potency would be fuller.
💬 Note from Doctor Luo: Renshen Baidu San is a famous formula for externally contracted illness — it is generally used when there is internal dampness, external wind-cold, and insufficient upright qi. Some even call it “the number-one epidemic formula of a thousand years”; in past epidemics it worked remarkably well. Later generations derived another famous formula from it: remove the ginseng and add jing jie (schizonepeta) and fang feng (ledebouriella), and it becomes “Jingfang Baidu San.” But here Doctor Yu was using it to treat dysentery — and that is where the subtlety begins.
Even more refined was the way the medicine was taken. Doctor Yu had the old man sit in an armchair, wrapped round with thick quilts, with a charcoal brazier burning underneath the chair; then he rolled a strip of cloth into a ball the size of a goose egg, placed it under the buttocks, and blocked the anus — so that the qi inside the body could not descend. When the medicine was decocted, the old man drank it scalding hot, in repeated draughts.
After drinking, the old man’s skin began to moisten with a faint sweat. Doctor Yu then poured scalding hot water over his skin to drive the sweating through thoroughly. At the same time he instructed the old man: when the urge to go came, hold it back with all his might, and do not move. They kept this up for about two double-hours (roughly four hours), and the moistness of the skin never dried out.
Finally the old man could stand it no longer — restless and fearful of heat, with the brazier burning below and hot water being poured on above, it was simply unbearable. Only then did Doctor Yu have him carried, quilts and all, to bed to lie down, making sure he did not catch a breath of cold air.
The result: only two bowel movements that night, fully cured in ten days
After all that effort, that night the old man passed stool only twice. From then on Doctor Yu switched to Buzhong Yiqi Tang — supplementing the center qi and lifting it upward, no more wind-dispersing, pathogen-scattering herbs. He was down to three movements in a day and night, and within not quite ten days, the recurrent dysentery that had tormented him through an entire autumn and winter was cured.
💬 Note from Doctor Luo: You see, his medicine-taking was an art in itself — blocking the anus, baking over a brazier, pouring hot water to force sweat. This is no ordinary way to take medicine! Doctor Yu explained it himself: “The pathogen that has sunk inside, I want to lift it and bring it back out through the exterior” — the pathogen entered from the exterior to the interior because the upright qi was insufficient; now he was making it leave by the same road it came in. He described it vividly: “If you do not apply the method of reversing the boat against the current, where will this downward rush ever stop?” Picture a river: the water pours downward with a roar, and the boat floats down with it. Unless you use the “reversing the boat against the current” method to haul the boat back upstream, how can that downward momentum possibly be halted? That is where the name “reversing the boat against the current” comes from.
A comparison case: why did the old doctor in Suzhou fail?
Doctor Yu also recorded a comparison case. He once met another Mr. Wang, who suffered from alcohol-induced dysentery (jiu li) — also long-standing diarrhea that would not clear, with no response to medicine. An old doctor in Suzhou also used Renshen Baidu San; after taking it the condition improved somewhat and showed great promise of life — yet in the end it failed.
Why? Doctor Yu said: because that doctor did not combine it with the methods of sitting in the chair, the brazier, and forcing sweat. So he said: “Whenever yang pathogen has sunk into the yin layer — as in prolonged malaria, prolonged dysentery, prolonged fever — you must grasp this meaning”: let it slowly, patiently, over time, work its way out to the exterior — that alone is the correct method. If you rush to cure it all at once, then I fear “it comes out only to sink back in, and you simply wound the upright qi” — the pathogen comes out and immediately falls back inside, and the upright qi is wasted for nothing. Because the root is insufficiency of upright qi, you must support the upright qi on one side while slowly drawing the pathogen outward on the other — support again, draw out again. That is the true path.
💬 Note from Doctor Luo: Some people today apply the “reversing the boat against the current” method to the early stage of dysentery — that is actually not right. Look at this case: what he had was recurrent dysentery, where the pathogen itself was no longer prominent. What was prominent was the disorder inside the body: first, insufficient upright qi — that is the core; second, the whole operation of the body had gone haywire — the qi mechanism had formed a fixed pattern of “everything goes downward,” the distribution of fluids was disrupted, the man barely sweated, and every fluid in the body, indiscriminately, was being sent out through the stool. The treatment was to turn this operating pattern back around.
Why is there not a single “toxin-clearing” herb in Renshen Baidu San?
Careful readers will notice: the formula is named “Baidu” — “expelling toxin” — yet it contains no toxin-clearing herbs at all. Huang lian (coptis), huang bai (phellodendron), bai tou weng (pulsatilla) — none of the standard anti-dysentery, toxin-clearing medicinals appears. So how does it cure dysentery?
💬 Note from Doctor Luo: It works by opening the channels. Ren shen (ginseng) is the sovereign herb — it supports the upright qi first: when your upright qi is insufficient, your fluids run chaotically; only by replenishing the upright qi do you gain the strength to change things. And note: in acute conditions you use ren shen — huang qi (astragalus) is gentler and slower, which is why the recovery formula, Buzhong Yiqi Tang, is where the huang qi comes in. Chai hu (bupleurum) and qian hu (peucedanum) draw the pathogen outward; qiang huo (notopterygium) and du huo (angelica pubescens) are wind herbs — they scatter wind pathogen and dissolve dampness. This is what the ancients meant by “wind can overcome dampness”: wind herbs can break up the dampness inside the body and reopen the fluid channels. Doctor Wu Jutong (吴鞠通) praised this approach as leading the pathogen from the yin layer up to the yang layer, from the interior out to the exterior. Zhi ke (bitter orange) moves qi upward; jie geng (platycodon) guides the medicine upward and opens the channels of the chest; fu ling (poria) drains dampness. Put together, these are all herbs for reopening the fluid channels. As for the fire and the hot water — they do two jobs: one, warm the yang qi; two, in concert with the wind herbs, force the dampness to leave through the skin as sweat, restoring the normal pattern of “what should go out as urine goes out as urine, what should go out as sweat goes out as sweat.” The body itself wants to recover; it simply lacks the upright qi to do it. Support the upright qi, open the channels, force the sweat — and the diarrhea cures itself.
Note from Doctor Luo: wind has its own “channel” too
Finally, Doctor Luo Dalun uses this case to talk about a fascinating topic — how wind affects the human body.
💬 Note from Doctor Luo: The body has many channels: heat has heat’s channel, cold has cold’s channel, and in fact wind has wind’s channel too. Some people say Chinese medicine’s talk of wind is too mystical — but wind can be measured. It has a wind speed; it changes temperature. A travelogue from a small Eastern European country once noted that the people there blamed “that damned draft” for every illness imaginable. The Chinese have an old proverb too — “the sage avoids wind as he would avoid arrows” — dodging wind like dodging an arrow; a thread of air slipping through a crack in the door really can strike like an arrow. Many of us have had this experience: drive with your elbow out the window, and the wind soon makes the joint ache. The ancients called wind “the chief of the hundred diseases” (feng wei bai bing zhi zhang): wind-cold, wind-heat, wind-dampness… when a tangible pathogen joins with intangible wind, the illness turns vicious — which is exactly why the ancients were so careful about drafts.
People with insufficient upright qi get diarrhea the moment the wind blows
Here is the key point: people with insufficient upright qi are especially sensitive to wind.
💬 Note from Doctor Luo: Some people have a weak gut and diarrhea often. Step outside and let the wind hit them — their stomach immediately starts gurgling and they have to rush back and go. The temperature change carried by the wind may not even be that cold, but they simply cannot take it. That is insufficiency of upright qi — the body is easily stirred by outside wind. People with a weak spleen and stomach often have gurgling in the belly, as if wind were moving around inside; Chinese medicine calls this “wind in the intestines” (chang zhong you feng). That is why many old practitioners, when treating diarrhea, like to add the wind herbs bai zhi (angelica dahurica), qiang huo, du huo and qian hu — with immediate effect. Who is most easily affected by wind? First, people with qi deficiency — qi deficiency tends to go with heavy dampness; second, people with both qi deficiency and water-dampness; third, people with yang deficiency. The therapeutic principle: whatever the organ disease, as long as it carries the “wind” character, herbs that scatter wind will often cure it. Everyone knows wind-dampness joint disease — the classic saying is “wind, cold and dampness three qi combine to form bi (obstruction),” and it is treated almost entirely with wind herbs to expel wind and free the channels. Well — treating diarrhea works on exactly the same principle.
What to take away: when diarrhea has run for months, look for the “downward habit” — and reverse the current
The heart of this case is one idea: when the pathogen has sunk from the exterior into the interior, you cannot just keep draining it downward — you must support the upright qi, reopen the body’s channels, and draw the pathogen back out the way it came in. That is the “reversing the boat against the current” method, born from a 73-year-old man’s recurrent dysentery.
💬 Note from Doctor Luo: Three practical takeaways for ordinary readers. First, chronic diarrhea that drags on for months is usually a disorder of the body’s operation, not an acute infection — the core issue is insufficient upright qi, and the qi mechanism has fallen into a “everything downward” rut; the treatment is to support the upright qi and pull the pattern back, not to keep taking more diarrhea medicine. Second, people with insufficient upright qi are easily stirred by wind — if a breath of wind makes your stomach gurgle and sends you running to the toilet, that is “wind in the intestines,” and wind-scattering herbs (bai zhi, qiang huo, du huo, qian hu) are a time-honored fix. Third, avoid drafts and protect your upright qi: “the sage avoids wind as he would avoid arrows” is not superstition — wind is the chief of the hundred diseases, and it hits the qi-deficient hardest.
Compiled from Doctor Luo Dalun’s commentary on Doctor Yu Jiayan’s case records; the case is from Yu Yi Cao (《寓意草》).