Bloody Stool for 30 Years and a Prolapsed Anus?
Patient’s own words: blood with the stool / bloody stool / prolapsed anus / rectum coming out / twenty-plus bowel movements a day / eating one thing and passing it unchanged
Medical terms: intestinal wind bleeding (chang feng xia xue) · rectal prolapse · spleen failing to command the blood · undigested food in the stool (wan gu bu hua)
An opening that makes you hold your breath
In the late Ming and early Qing dynasties, the famous Jiangxi physician Doctor Yu Jiayan took on a patient that almost everyone had written off: no hope. The man had passed blood with his stool for nearly thirty years. Last winter he suddenly hemorrhaged in a great gush, and this spring it got worse — he passed whatever he ate exactly as it went in, and his anus had prolapsed three to five cun (roughly 10–16 cm), with twenty-odd bowel movements in a single day and night. He had withered away. Yet Doctor Yu Jiayan said it straight to the patient’s face: this disease can be saved.
💬 Note from Doctor Luo: This case comes from Yu Jiayan’s Yu Yi Cao (《寓意草》, “The Grass of Meaningful Words”). Yu Jiayan (1585–c. 1664) was a great physician of the late Ming and early Qing from Xinjian, Jiangxi. He had studied Buddhism and meditation and was broadly learned in the classics, and his medical reputation was enormous. He had a distinctive habit — he loved writing long treatises: laying out the cause, the mechanism, and the reasoning behind every herb in meticulous detail. In this case he presented “five reasons the patient can be saved” right in front of the man, like a scholar defending a thesis. Why was he so exacting? Because the previous patient had suffered precisely from things “not being explained clearly” — that story comes at the end.
Who was the patient? A plump, healthy-looking old sufferer of “intestinal wind bleeding”
The patient was a man named Chen Yanzhi. Doctor Luo notes that he was stout and strong-looking — very fat, appearing quite robust. But he had carried this illness for nearly thirty years.
What is chang feng xia xue (intestinal wind bleeding)? Doctor Luo explains: this is an old term — “intestinal wind” (chang feng) means wind in the intestines, a constitution prone to diarrhea; “xia xue” means blood descending in the stool. The illness comes and goes like wind, in waves, suddenly.
What was Chen Yanzhi’s daily life like? Occasional small bleedings — when nothing was wrong he would pass a little blood, rest a while, and it would pass. His body never seemed to suffer much. So for thirty years he stayed plump and looked quite sturdy.
💬 Note from Doctor Luo: On the subject of bloody stool, Doctor Luo takes a moment to help everyone recognize the different kinds. Bloody stool divides into several types: bright fresh red blood usually comes from the lower digestive tract — a bleeding hemorrhoid, for instance; very dark, even black blood may be upper gastrointestinal bleeding (from the stomach, say), where the blood turns black as it passes through digestion; and jam-like, jelly-like blood is a warning to take seriously the possibility of something grave like rectal cancer — some people assume it is only hemorrhoids when it is actually bowel cancer. That jelly-like bloody stool deserves special vigilance. Know the colors of bloody stool, and don’t delay.
💬 Note from Doctor Luo: Notice the phrase “stout and strong-looking” — looking robust is not the same as being robust. Chinese medicine speaks of “xing sheng qi xu (full form, deficient qi)”: a person who is fat and looks strong often actually has insufficient zheng qi (upright qi). By the time the illness worsens, you will understand: that flesh was all false plumpness, an illusion. Doctor Luo often says: look at the constitution first, then at the disease — don’t be fooled by a surface “robustness.”
The sudden turn: last winter, a great gush of blood
Last winter Chen Yanzhi suddenly bled several dou of blood (a dou is a large volume measure) — an enormous amount. This was no joke.
💬 Note from Doctor Luo: Doctor Luo explains this for everyone — “bleeding several dou” sounds terrifying, but in fact this kind of blood is accumulated: blood gathers in the bowel and doesn’t come out until a bowel movement, piling up more and more. When the patient finally goes, it all sprays out at once, which looks horrifying and makes the patient gasp “I lost several dou of blood!” In reality it wasn’t that much — it was one accumulated release. If blood were truly pouring out continuously day after day, the person would have bled to death long ago. Keep this in mind and don’t be frightened by the phrase.
Why did it happen so suddenly? Doctor Yu Jiayan’s judgment: excessive worry and melancholy had injured both the liver and the spleen.
💬 Note from Doctor Luo: Mr. Chen was a man with a heavy heart — he brooded all day. Too much scheming and worry injures the spleen; a depressed mood injures the liver. The liver is “the organ that stores blood,” and the spleen is “the organ that commands blood”: when the liver is hurt it cannot store blood; when the spleen is hurt it cannot hold blood. With both injured, blood easily escapes — hence the sudden gushing. Worry injures the spleen; melancholy injures the liver. Ancient doctors took this mechanism very seriously, and modern people under pressure have exactly this kind of illness in great numbers.
Properly, he should then have been treated with strongly tonifying the spleen and securing the qi. Unfortunately the illness was not properly treated and dragged on into spring — when liver wood is at its strongest and the earth (spleen) is weakest, the spleen qi sinks still further and the bleeding grows worse. The wind of liver wood and the intestinal wind fanned each other, the blood sank downward, and wan gu bu hua (undigested food in the stool) set in: the grain he ate had no time to be digested and shot straight out, “eat one thing, pass that thing,” as if his gut were a straight pipe.
Critical condition: anus prolapsed three to five cun, twenty-plus bowel movements a day
By this point the illness was frighteningly severe:
- The anus prolapsed three to five cun — his qi was too deficient to hold anything in; the rectum came out and there was no strength to draw it back. After each bowel movement he had to bathe the area in hot water and push it back in by hand — then the next trip to the toilet pushed it out again;
- Over twenty bowel movements in a day and night — misery beyond words;
- His face was swollen with no luster at all; his lips were dry, cracked and scorched-looking; his nostrils were black, as if smoked over a fire.
Every sign of a hopeless case was visible to all. The physicians called in to feel his pulse shook their heads one after another: how could this possibly be treated?
💬 Note from Doctor Luo: Remember this signal — when qi deficiency reaches a certain depth, the bowel will prolapse and bleed. This is not heat forcing the blood to run; it is the spleen failing to command the blood, qi too deficient to secure and hold. Children with weak qi also commonly get rectal prolapse. And “black nostrils” was regarded by the ancients as a critical sign — yet Doctor Yu Jiayan insisted there was still hope. Why? Because he saw the vitality that others missed.
The diagnostic highlight: Yu Jiayan lays out “five reasons the patient can be saved”
After feeling the pulse very carefully, Doctor Yu Jiayan stated the case to the patient face to face — this is what the ancients called “in a critical illness, deciding whether anything can be done”: though the condition was grave, there were five reasons it could be saved. He presented them one by one:
First, the yin blood has not been exhausted. If the yin blood were truly used up, the person should no longer be able to see — qi and blood could no longer rise to nourish the eyes. But Mr. Chen’s eyes were bright and spirited, which showed that the yin above (the upper yin qi) was still present.
Second, the yang qi has not been exhausted. If yang qi were spent, the person should be sweating cold oily sweat and seeing ghosts everywhere. But Mr. Chen sweated little, and had only seen ghosts twice — which showed that the yang qi within the spleen had not yet departed, and the qi of the other organs was preserved.
Third, the stomach can still hold grain. He ate without vomiting or nausea, which meant the organs were still connected and communicating — not yet at the “terminal” stage. As long as stomach qi survives, there is still a chance.
Fourth, he can still sleep at night. Though he struggled to fall asleep, he rested a good deal with his eyes closed, without alternating chills and fever or sudden waves of heat and cold sweat — which showed the liver’s function of storing blood was still intact. When liver blood is disturbed, a person becomes dazed, manic and feverish; he had not reached that state.
Fifth, though the pulse is soft and weak, the chi (foot) pulse has root. His pulse was soft and lacking strength, yet between the two chi positions one could still feel a thread of force — which showed his original constitution was still decent and could bear tonification.
💬 Note from Doctor Luo: These five points are the classic framework for judging whether a critical patient still has vitality: look at the yin, look at the yang, look at the stomach qi, look at the liver, look at the root of the pulse. Doctor Yu Jiayan’s conclusion: the man’s spleen had been beaten, and he had gone a long time without correct treatment, so his qi was close to “the final breath” — but not yet at it. Here he quoted the Nei Jing (Inner Canon): “Yang qi is like the sky and the sun; if it loses its place, life is shortened and one’s virtue is unseen” (阳气者，若天与日，失其所，则折寿而不彰). Yang qi is like the sun in the sky — once the sun sets, all living things end. The whole crux of life and death lay in whether the yang qi inside the spleen could recover. If the yang qi recovered, he could eat, transform food, the diarrhea would stop, and the anus would draw itself back in.
The prescription, taken apart: four herbs, one to tonify and one to hold — “welding” the qi inside the body
So how was it treated? Doctor Yu Jiayan’s method was — tonify qi and warm yang, but no drastic herbs; it had to go slowly.
The main herbs were ren shen (ginseng) and bai zhu (atractylodes): ginseng tonifies qi, atractylodes tonifies the spleen, building up the yang qi within the spleen bit by bit. But here was the problem: Mr. Chen’s intestines were absorbing nothing. Whatever medicine he drank passed straight out the other end — tonifying alone would not work.
What to do? Doctor Yu Jiayan paired in two astringent herbs: chi shi zhi (halloysite) and yu yu liang (limonite), made into pills so the medicine’s action would “linger” in the gut.
💬 Note from Doctor Luo: This is Doctor Yu Jiayan’s brilliance — tonify qi and astringe at the same time. The ginseng and atractylodes supply the qi; the halloysite and limonite “hold” the medicine’s action and the zheng qi inside the body so it cannot leak away — like charging a battery while turning off the short-circuit. In the Shang Han Lun (Treatise on Cold Damage), Zhang Zhongjing treated “unending diarrhea” with exactly halloysite and limonite, and Doctor Yu Jiayan knew the Shang Han Lun thoroughly — he handled it with complete ease.
How was it used? First, ginseng was decocted into a soup and halloysite powder was taken down with it — astringing on one side, tonifying qi on the other. After drinking it, the patient became “somewhat settled,” and the illness began to ease. Then the four herbs — ginseng, atractylodes, halloysite and limonite — were made into pills for him to take slowly. And the result?
After taking the medicine, he was completely cured.
💬 Note from Doctor Luo: Just four herbs brought back a patient everyone had declared hopeless. What does this case show? It shows that Doctor Yu Jiayan’s diagnosis was accurate, his pattern-recognition was accurate — a severe illness is not the same as a hopeless one; the key is to see clearly whether vitality still remains. Look at how ancient doctors analyzed cases in such fine detail — that is the model we should study today.
Bonus: why can two “dirt-eating” medicines cure disease?
The two most unusual herbs in this case are chi shi zhi (halloysite) and yu yu liang (limonite) — both are minerals. Many patients, on seeing them, think: isn’t this just earth? Can you eat it? Doctor Yu Jiayan’s previous patient literally died of this “dare not use it” (story below). Doctor Luo takes a moment to explain these two herbs.
Chi shi zhi (halloysite): a kaolin-type clay mineral. What does it do? Astringe — in the intestines it has a powerful adsorbent effect: it can bind harmful substances and hold them, and it astringes to stop bleeding.
💬 Note from Doctor Luo: Don’t think “eating dirt” is strange. When children have diarrhea today, the hospital-prescribed smectite (蒙脱石散, dioctahedral smectite) is essentially the Western version of this clay — the French also discovered that this mineral has strong adsorptive properties and used it very effectively for chronic diarrhea. And if we go further back, watch any nature documentary: when a parrot accidentally eats something toxic, it will go find a particular kind of earth and eat it, using the clay to adsorb the poison and keep its gut stable. This is a method nature provides to living beings for keeping the intestines balanced — East and West alike, even animals know it.
The ancients used halloysite very widely: they divided it into five colors, each said to astringe the essence of one of the five organs; later the red and white were commonly used, and the red was preferred for medicine. Red enters the heart; sweet enters the spleen — it astringes the spleen channel and, entering the blood aspect, regulates blood, hence it stops bleeding. Bloody stool, women’s uterine bleeding (beng lou), hemorrhoids, and skin sores — the ancients all used it to astringe and regulate the blood. Zhang Zhongjing’s Tao Hua Tang (Peach Blossom Decoction) contains halloysite. In famine years of old, halloysite could even be eaten as food.
Yu yu liang (limonite): an iron-oxide mineral. Legend says that when the Great Yu tamed the floods, his leftover grain turned into this stone — hence the name “Yu’s leftover grain.” It is slightly cold, yellow in color, and enters the spleen; it too astringes and stops bleeding, and works especially well for spleen-channel bleeding and diarrhea. Researchers have tested it: giving raw limonite and vinegar-calcined limonite separately to mice, the effect on intestinal motility really does differ; it stops bleeding, yet at times it can also move blood — a bidirectionally regulating medicine.
💬 Note from Doctor Luo: These two herbs were commonly used by the ancients, and later Doctor Zhang Xichun also used them for severe diarrhea. But today many people no longer dare use them — they flinch at the sight of a mineral. In fact these were among the most common “heavy” medicines of antiquity — halloysite in particular was thought by the ancients to benefit health: for people with unhealthy guts, constant diarrhea, and a need for holding and securing, once the securing was sufficient and the zheng qi sufficient, the body naturally became healthy. When there’s a chance in future, we’ll talk specifically about halloysite — the range of diseases it treats is very broad, far beyond diarrhea and uterine bleeding.
The other side of the story: the high official who wouldn’t eat “dirt”
With the case finished, Doctor Luo turns to a contrasting story that makes one sigh.
Just before this, Doctor Yu Jiayan had also treated a high official — Shao Sima, Mr. Li Pingcai, who had returned from leading troops in Liaodong and fallen ill. To be honest, his illness was much milder than Chen Yanzhi’s, yet the ending was the exact opposite:
💬 Note from Doctor Luo: Doctor Yu Jiayan wrote Mr. Li Pingcai a very detailed case record — how the illness began, how the medicine should be used, and the reasoning behind it, all written out clearly. It was taking the practice of medicine to its extreme. But who would have guessed: after reading this “long thesis,” Mr. Li Pingcai instead grew suspicious: how can there be earth in this medicine? Can you eat a mineral? And so — the medicine was never taken, and the man passed away. Doctor Yu Jiayan later wrote the whole affair down, full of regret: he had written that case record precisely to explain the reasoning thoroughly, and instead it bred doubt. Ironically, if you search for “Li Pingcai” online today, every result is Doctor Yu Jiayan’s case articles.
What truly survives is the medical skill — fame, rank, position: none of it matters. Chen Yanzhi, whose anus had prolapsed three to five cun, who went to the toilet twenty-plus times a day, whom almost no one dared to treat, was saved by four herbs; while the powerful official with a far milder illness lost his life to doubt over two minerals.
What to take away: when the qi is too deficient, nothing can be held in
The core of today’s case is one sentence: when the qi is too deficient, nothing can be held in.
💬 Note from Doctor Luo: Blood with the stool, a prolapsed anus, eating one thing and passing it unchanged — these frightening symptoms usually share one root: qi deficiency failing to secure and hold. When the spleen fails to command the blood, the blood runs downward; when qi cannot secure, the bowel descends. The key to treatment is not simply to stop the bleeding or stop the diarrhea — it is to use qi-tonifying herbs like ginseng and atractylodes well, build the qi back up, and then pair halloysite and limonite to hold the zheng qi fast. Remember: this kind of bleeding is not “heat forcing the blood to run” — it is “qi deficiency failing to hold.” Get the direction wrong, and every treatment makes the deficiency worse. Next time someone has blood in the stool with a prolapsed anus, first ask — is the qi simply too deficient?
Based on Doctor Luo Dalun’s commentary on the case records of Doctor Yu Jiayan; the case is from Yu Yi Cao (《寓意草》).