Diarrhea After Drinking That Lasted for Years? Doctor Zhang Jingyue Cured His Own Case by Warming the Spleen and Kidneys

Patient search terms: diarrhea after drinking / loose stools when I drink / chronic diarrhea / diarrhea that has lasted years / morning diarrhea

Medical terms for this condition: jiu xie (wine-related diarrhea) · chronic diarrhea · spleen-kidney deficiency-cold · Weiguan Jian (Stomach-Gate Decoction)

Opening: a famous doctor with diarrhea — for five or six years

Imagine a famous physician who spends every day diagnosing patients and writing prescriptions — yet has had diarrhea himself for five or six years and never managed to cure it. Wouldn’t that be embarrassing?

That is exactly what happened to Doctor Zhang Jingyue of the Ming dynasty. He wrote it down quite honestly in his own book: in his early 40s, he had diarrhea for years and could not get well. And this was a master physician! We all eat the five grains and drink the waters of this world — who doesn’t have some ailment? The difference is only that some people solve theirs early and some solve theirs late. What makes Zhang Jingyue extraordinary is that he treated his own illness as a research subject, studied it seriously, and in the end really figured it out.

💬 Note from Doctor Luo: I enjoy reading Zhang Jingyue’s books because the man was so down-to-earth. Most famous physicians would never admit to their own problems. He wasn’t afraid — he wrote out the whole story of his diarrhea: “The situation had become embarrassing” (qing shi yi jiong) — he himself felt awkward about it: you’re a doctor of Chinese medicine, you see patients every day, and yet you have diarrhea yourself, so you have to “look for a method of treatment out of necessity” (yin bian qiu zhi fa), and begin studying how to treat diarrhea. That kind of candor is extremely rare among the ancients.

Who was the patient? A staff officer who had fought wars and loved his drink

Zhang Jingyue — personal name Jiebin, style name Jingyue — was born in Shaoxing, Zhejiang province. He would later become the patriarch of the warming-and-supplementing school and earn the nickname “Zhang Shudi” (Zhang of the prepared rehmannia). But in his early 40s he had not yet formally practiced medicine. In his youth he had served in the army as a staff officer, joining the famous general Li Rusong in the campaign into Korea against Toyotomi Hideyoshi (the anti-Japanese aid-to-Korea war of the Wanli era), spending years with the troops.

What is the style of a soldier? Drinking. Army life is free and hearty — he drank with officers and with soldiers, the liquor pouring down. When he later analyzed the cause of his illness, he stated it plainly: years of campaigning and traveling had injured his yang qi; add in staying up late, exposure to cold and long forced marches, and his spleen yang was insufficient — the yang of both spleen and kidney was depleted. The wine was only the trigger; the root had been planted long before.

💬 Note from Doctor Luo: I often say that sitting in a room practicing wellness every day does not guarantee you’ll stay healthy. In the army you endure cold, sleepless nights and round-the-clock exertion — it’s perfectly normal for the body to develop problems. Zhang Jingyue only really became famous after he was past 50. In his 40s he was still an ordinary man carrying the habits of a soldier. This illness was accumulated exactly that way.

What did he do first? He read through the entire Huangdi Neijing

So what do you do when you have chronic diarrhea? The first thing Zhang Jingyue did was not to write a prescription in a hurry — it was to open the books. In his Jingyue Quanshu, in the Za Zheng Mo (chapter on miscellaneous syndromes), section on diarrhea (Xie Xie), he begins by collecting and quoting every passage about chronic diarrhea in the Huangdi Neijing (Yellow Emperor’s Classic of Internal Medicine), arranging them one by one.

For example, the Suwen, Jinkui Zhenyan Lun (Plain Questions, chapter on the True Sayings of the Golden Coffer) says: “In long summer, people are prone to dong xie — pouring diarrhea from cold in the middle.” Long summer brings dampness; add cold, and you easily get dong xie — the water pouring straight out. You see, this is discussing the illness from the angle of cause. The Neijing talks a great deal about how diarrhea arises and puts great effort into etiology; as for treatment methods, it says less.

💬 Note from Doctor Luo: If you read through everything the Neijing says about diarrhea, you could lecture on it for days — the material is extremely rich. Zhang Jingyue organized all of it, then explained how to differentiate the pattern — which part of the body is out of balance? Which external pathogen has arrived? Then the treatment categories follow. But here is the general principle to tell everyone first: in diarrhea, the water all leaves through the intestines, so urine becomes scanty. What to do? Promote urination — increase the volume of urine, letting the large intestine dry out, with the water going out through the urine. This is called the “separating and promoting” method (fen li). It is the grand direction in treating diarrhea.

The classification of diarrhea: find your own type

Zhang Jingyue wrote out the various situations of chronic diarrhea in great detail. Let me sort them out for you:

• Bao xie (sudden diarrhea): diarrhea that comes on suddenly, often linked to what you ate — unclean food, food stagnation, or an external contraction; all are “the fault of the mouth and belly” (kou fu zhi gu);
• Spleen-deficiency diarrhea: people with weak spleen qi and insufficient yang — eat slightly wrong, catch a little cold, and they run to the toilet. This needs slow nourishing, with formulas like Yangzhong Jian (Nourish-the-Center Decoction), Wenwei Yin (Warm-Stomach Decoction), Sijunzi Tang (Four Gentlemen Decoction) and Wujunzi Jian (Five Gentlemen Decoction);
• True-yin deficiency (kidney-essence deficiency) diarrhea: pain below the navel, or worse in the morning; food not digested — what comes out is still in its original form (wan gu bu hua). This is a kidney problem and has little to do with the spleen-stomach. Zhang Jingyue specifically notes that what he calls “true yin” can basically be equated with “kidney essence.” This kind of diarrhea may drag on for years. The ancients used Jiaofu Wan (Pepper and Aconite Pill), Weiling San and similar formulas; Zhang Jingyue himself created Weiguan Jian, Yidan Dan, Jiudan Dan and Fuyang Dan;
• Long diarrhea without fire: diarrhea lasting so long that the spleen and kidney become deficient and cold — even to the point of wu geng xie (dawn diarrhea, the bowel movement that always comes before daybreak);
• Xie tuo (collapse): pouring diarrhea until the person faints — a critical situation where qi, yang qi or yuan qi (original qi) is about to escape. Use Siwei Huiyang Yin and Liuwei Huiyang Yin;
• Qi diarrhea: diarrhea that pours out whenever you get angry — eating while angry, rage mixed with food; the liver qi runs wild and injures the spleen-stomach, and any trigger brings on an attack. Nuan Gan Jian (Warm the Liver Decoction) can be used;
• Wind diarrhea: a special type — an external pathogen enters the body and gets stuck in the intestines without leaving. The characteristic sign: diarrhea whenever the wind blows — you go outside, the wind hits you, and the intestine reacts even faster than the skin; you’re in the bathroom before anyone else. Some people instead get diarrhea on very hot days. You must distinguish wind-cold from wind-heat.

💬 Note from Doctor Luo: Many of you will recognize wind diarrhea from experience: a gust of wind and your stomach turns — you reach the toilet faster than anyone. Zhang Zhongjing has relevant formulas for regulating it; the main approach is supplementing the spleen, plus a little dispelling-wind, scattering-pathogen medicine — wind herbs like bai zhi (angelica dahurica), du huo (double-teeth pubescent angelica), qiang huo (notopterygium) and fang feng (siler) — and the results are especially good. Zhang Jingyue basically wrote down every cause and every situation of chronic diarrhea for you. If you want to find yourself in the list, open the book and look up your own entry.

The star of the show: wine diarrhea — wine has a yin side and a yang side

The type that matched Zhang Jingyue’s own condition most closely is the wine diarrhea pattern (jiu xie): diarrhea after drinking. Why does this happen? He says wine has a dual nature of yin and yang. People usually call wine damp-heat, but Zhang Jingyue proposed: “The nature of wine is hot; the substance of wine is cold” (jiu xing ben re, jiu zhi ze han). Wine also has a cold side. Two people can drink the same wine — one shows damp-heat, the other shows cold. They are not the same.

💬 Note from Doctor Luo: Let me explain this in detail. Wine is a fermented product. Today’s liquor-making is rigorous — the baijiu (white liquor) we drink is distilled, generally no big problem, and it’s simply hot; grape wine, by contrast, is cool in medicinal nature. But in the old days people drank wine they brewed themselves. I used to live in Hainan and often visited the villages — outside the storehouses you’d see bottles of home-brewed rice wine standing one after another (the shanlan wine of the Hainan Li ethnic minority, which the locals call biang wine). Every batch has a different microbial population; if the fermentation isn’t controlled well, people who drink it easily get diarrhea. I’ve experienced this myself: I went up the mountain, saw some wonderful home-brewed wine, drank happily — and came home with pouring diarrhea. So Zhang Jingyue’s point that wine can be cold or hot is genuine.

How did the famous physicians of antiquity treat wine diarrhea? Zhang Jingyue studied them all:

• Zhu Danxi said: people injured by wine “will inevitably have diarrhea every morning on rising.” What to do? Lizhong Tang plus ge gen (kudzu root), or swallow wine-boiled huanglian (coptis) pills — Lizhong Tang warms the yang, the huanglian pill clears heat; he covered both cold and heat;
• Wang Jiezhai (Wang Lun) said: diarrhea on drinking is “wine-accumulation heat diarrhea,” and used huanglian, yinchen (oriental wormwood), gan jiang (dried ginger), mu xiang (costus root) and bai zhu — huanglian and gan jiang, one cold one hot, balancing cold and heat together;
• Xue Lizhai (Xue Ji) said: if the wine-damp has not dispersed and the spleen qi is not yet deficient, use the same kind of medicine to separate and promote damp-heat; if the damp-heat has already gone and the middle qi has been injured, use Liujunzi Tang to regulate and supplement the middle qi. He also said that the nature of wine is greatly hot and it is a formless substance; when the formless yuan qi is injured, one should use Gehua Jiecheng Tang to separate and disperse its dampness.

Zhang Jingyue’s verdict on each school: Zhu Danxi “used huanglian whether the pattern was cold or hot” — though Doctor Luo points out this is actually a little unfair to Zhu Danxi, since he did first mention Lizhong Tang plus ge gen (warming the yang)! Wang Jiezhai also used huanglian — Zhang Jingyue said this only proves that “one knows wine has heat but does not know wine has cold,” and cannot serve as evidence. What he approved of most was Xue Lizhai’s line: “The nature of wine is greatly hot; what it injures is the spleen.”

The setbacks: he tried every famous formula — none of them worked

So Zhang Jingyue started drinking decoctions — first Gehua Jiecheng Tang. This is Li Dongyuan’s formula: ren shen (ginseng), bai zhu (atractylodes) and fu ling (poria) to strengthen the spleen, chen pi (tangerine peel) to move qi, zhu ling (polyporus) and ze xie (alisma) to drain dampness outward, plus ge hua (pueraria flower) to resolve the alcohol — the classic hangover formula for “drank too much, spleen-stomach injured.” He thought: my diarrhea was caused by drinking, so let me resolve the alcohol. No effect.

Then he took Liujunzi Tang and Buzhong Yiqi Tang — no effect. Then Lizhong Tang and Bawei Wan (Guifu Dihuang Wan, the cinnamon-and-aconite rehmannia pill) — still no effect. At that point he wrote a very honest sentence: “ji qiong li jie” — all his strategies were exhausted and his mind was worn out. He couldn’t understand it himself: this illness ought to be easy to adjust — why did it not respond when it was his own body? He even felt “as if there was no hope of living on” — as though the condition would shorten his life.

💬 Note from Doctor Luo: This is the growth journey of a famous doctor: he didn’t just sit down and conjure up a formula. First he had to see how the ancient doctors explained things, and he had to learn. He tried Zhu Danxi’s, Wang Jiezhai’s and Xue Lizhai’s approaches — none fit. Why? Because his root cause was not damp-heat but deficiency-cold. The famous masters all thought toward “wine heat.” Only Xue Lizhai’s line “the nature of wine is greatly hot; what it injures is the spleen” stayed with him: yes, the wine is hot — but what it wounds is precisely the spleen and stomach!

The turning point: “Unless the ming men is vigorously supplemented, there will never be a cure” — three formulas of his own

Setting aside the famous formulas, Zhang Jingyue calmed down and seriously studied his own illness. Finally he understood: “Fei jun bu ming men, zhong wu yu ye” — “Unless the ming men (life gate) is vigorously supplemented, there will never be a cure.” The illness was definitely one of deficiency, and the fire of the ming men had to be thoroughly built up! So he created his own formulas — Weiguan Jian (Stomach-Gate Decoction), Yougui Wan (Restoring the Right [Kidney] Pill) and Yidan Dan (One-Qi Elixir) — and rotated among them.

These three formulas are all famous. Let’s take them apart:

Weiguan Jian (Stomach-Gate Decoction). First, the name: Chinese medicine has a saying — “The kidney is the gate of the stomach” (shen wei wei zhi guan). The final constraint on the spleen and stomach is the kidney; it is the kidney that governs this gate. Name a formula “Stomach-Gate Decoction” and you know exactly where it is aimed — at regulating the kidney. Its chief indications are spleen-kidney deficiency-cold with diarrhea, even chronic diarrhea, unrelenting abdominal pain and cold diarrhea. The composition: shu di huang (prepared rehmannia) — 3 qian, 5 qian, even 1 liang (about 9–30 g), a large dose — to supplement kidney essence. This is the most brilliant point of the whole formula. Zhang Jingyue’s experience: only after the kidney essence is filled can you successfully supplement yin and yang; every later school of kidney-supplementing followed him in this. Then shan yao (Chinese yam, stir-fried) and bai zhu (atractylodes, stir-fried) to strengthen the spleen; bai bian dou (white hyacinth bean, stir-fried) to strengthen the spleen and stop diarrhea — bai bian dou must be stir-fried; raw it is mildly toxic, just like string beans that haven’t been cooked through; pao gan jiang (dried ginger fried black) to warm the yang; wu zhu yu (evodia) to warm the liver and the yang; zhi gan cao (honey-fried licorice) to supplement the middle. The core: shu di, shan yao, bai zhu, bai bian dou — warmed up with gan jiang and wu zhu yu.

💬 Note from Doctor Luo: Zhang Jingyue wrote out the modifications of Weiguan Jian very clearly — everyone remember them: if the diarrhea is too severe, add rou dou kou (nutmeg) and po gu zhi (bu gu zhi, psoralea fruit); if qi is deficient, add ren shen (ginseng); if yang deficiency is severe and the lower burner is not secure — so cold that any movement brings diarrhea — add fu zi (aconite); if there is abdominal pain, add mu xiang (costus root) or hou po (magnolia bark); if there is stagnant pain with obstruction, add dang gui (Chinese angelica); if the diarrhea pours out beyond control, add wu mei (smoked plum) and bei wu wei zi (northern schisandra) to astringe; if the liver qi is invading the spleen (wood overpowering earth), add rou gui (cinnamon bark).

Yougui Wan (Restoring the Right [Kidney] Pill). Zhang Jingyue’s idea: take Jinkui Shenqi Wan (the Eight-Ingredient Pill, Guifu Dihuang Wan) and remove its “draining” herbs, keeping only the “supplementing” ones — when deficiency has reached this level, what is the use of continuing to drain water and dampness? He was too depleted, so supplement everything! The three tonics — shu di huang, shan yao and shan zhu yu (cornus fruit) — stay; the three drainers — ze xie, fu ling and dan pi (moutan bark) — go; in their place come the yang-warming gou qi zi (wolfberry), lu jiao jiao (deer antler glue), tu si zi (dodder seed) and du zhong (eucommia bark), plus dang gui to nourish the blood (for those with loose stools, leave out the dang gui). Yidan Dan (One-Qi Elixir) is even simpler: ren shen to supplement qi and fu zi to warm the yang. The common character of these formulas: supplement plus warm the yang — a single, pure, focused strength.

The result: cutting out the wine, warming the spleen and kidney — nearly a year of adjustment

Once the direction was right, the rest was persistence. Zhang Jingyue, on the one hand, brought the drinking under control (the wine, he said, was only a trigger), and on the other hand used these formulas to supplement the spleen and kidney and gradually warm the yang back up. The result: after adjusting for more than a year, he was completely cured (tiao li yu nian, jing de quan yu) — nearly a year, and the illness was gone for good.

💬 Note from Doctor Luo: Some of you may find it strange: a physician as famous as Zhang Jingyue took a whole year to fix his own diarrhea — surely that’s not very impressive? I say it is. Everyone has a growth process. He was in his 40s then, not yet at his peak, and he had collected a body full of ailments in the army. Besides, chronic diarrhea does not form in a day — it accumulates over years, and adjusting it is inherently difficult. Some patients improve and relapse in turns. In my own practice I often borrow the idea of Wu Mei Wan (Mume Pill) to adjust such cases; some really are deficiency-cold, and there I warm the yang — but some are very hard to adjust. Especially people whose intestinal flora has been completely disrupted: getting them back in order is extremely difficult — the internal ratios in the gut have changed; we say “the spleen’s qi has become chaotic,” and resetting it is hard work. Some recover quickly; others are just getting well after a month, and one little indulgence, a little drink, and it pours out again. So Zhang Jingyue curing himself in a year is real skill.

After he recovered, Zhang Jingyue said: from then on I understood the ultimate principle of this illness, and when I treated people with it afterward, the results were excellent — he saved many patients with the same complaint. He also reflected: if, as he had done before, you have “no firm view” (wu que jian) — no settled understanding in your heart — and only know how to say “damp-heat” and clear damp-heat, wrongly using huanglian and ge gen to separate and promote — how could that possibly cure anyone?

What to take away: look past the diarrhea to the root — the spleen and kidneys

Finally, Doctor Luo draws out the principle behind Zhang Jingyue’s story:

💬 Note from Doctor Luo: Zhang Jingyue’s experience gives us a model to think from — with wine-related diarrhea, consider this line of thought: sometimes it is damp-heat, and sometimes it genuinely is cold. But the ultimate root must be regulated through the spleen and kidneys. A great many men past middle age have quite deficient spleens and kidneys. What you see is chronic diarrhea — they seem to have eaten nothing, yet they always have loose stools, while other people eat the same food and are fine. Where is the root? The root is that the spleen and kidneys have gone wrong. Supplement them slowly. Once they are restored, the stopping of the diarrhea is actually a minor matter; when kidney qi is full and the spleen-kidney are sufficient, your whole body condition improves, and a person’s years may even lengthen. If instead you drag on with a depleted spleen and kidney, on the surface it looks like just diarrhea — but underneath, other problems in the viscera will multiply.

So some famous doctors really do experiment on their own bodies, and in regulating themselves they slowly come to understand what a disease truly is. Methods born from personal practice work especially well for patients with the same pattern — Zhang Jingyue later cured countless patients with wine-related and long-lasting diarrhea using this approach. Your body is your own. Nourish the spleen and kidneys well and keep this “gate” guarded — that is better than any miracle drug.

Arranged from Doctor Luo Dalun’s commentary on Doctor Zhang Jingyue’s medical cases. The original case appears in the Jingyue Quanshu (Complete Compendium of Jingyue), chapter on miscellaneous syndromes, section on diarrhea, by Doctor Zhang Jingyue (Ming dynasty, published 1624).