Eight Years of Chronic Diarrhea, Then Sudden High Fever with Delirium and Eyes That Wouldn’t Close: Doctor Miao Xiyong Saves the Acute Crisis First, Then Cures the Eight-Year Diarrhea

Patient’s search words: diarrhea for eight years / chronic diarrhea / fever with delirium / eyes won’t close / headache like splitting / a person with chronic diarrhea suddenly gets a high fever Medical terms: chronic diarrhea (mixed cold and heat) · external-contraction febrile disease (excess heat in the yangming level) · delirium

Opening: this famous physician came to patients at a gallop, on horseback

In the late Ming dynasty, in the Changshu region of Jiangsu Province, there lived a famous physician named Doctor Miao Xiyong. Other doctors made house calls in sedan chairs; he rode a horse. The moment a summons arrived, he would whip his horse and race off to save a life — a true knight-errant of medicine. What was he best at? External-contraction febrile illness — especially heat syndromes: high fever, and drawing the heat out. He had profound insight into these cases. The later master Doctor Zhang Xichun, who became famous for using raw gypsum (sheng shi gao) in daringly large doses, was directly inspired by Miao Xiyong.

💬 Note from Doctor Luo: External-contraction disease has always been one of humanity’s great enemies — even today we still have to fight it. When a plague arrives, the West often has few answers and people simply endure it; the United States lost over a million lives to COVID. Chinese medicine, by contrast, has many strategies. So never underestimate external-contraction disease, and don’t casually file it under “an ordinary cold” — some febrile illnesses are genuinely severe.

Who was the patient? Mr. Yu, who had been running to the toilet for eight years

The patient that day was named Yu, given name Jiqing. And this gentleman had a distinctive habit: he did not avoid pork. In ancient times, pork was actually eaten rather little — the Song-dynasty imperial palace consumed tens of thousands of sheep a year, and mutton was the staple meat. People believed pork could “stir up wind and generate phlegm,” and since it is yin-nourishing and on the cool side, ordinary folk ate it sparingly. Old Yu was the exception: he not only ate pork, he loved to drink wine as well.

💬 Note from Doctor Luo: A quick story — why did Su Dongpo invent “Dongpo pork”? During his exile, he was so poor he couldn’t afford mutton, so he took pork and braised it slowly with Sichuan pepper and other spices until it was meltingly soft, making it taste almost like mutton — a substitute for the lamb he couldn’t buy. So Dongpo pork was originally “poor man’s lamb.” Pork nourishes yin and is on the cool side, so you have to cook it thoroughly with warming spices, or it will harm the body.

Yu Jiqing followed this diet for years, and it planted a seed of illness: zuo xie ba zai — he had diarrhea for eight straight years. After so many years of chronic diarrhea, a person naturally grows weaker and weaker.

The sudden crisis: a headache like splitting, and eyes that would not close for seven days

Before the eight-year diarrhea was even addressed, a serious illness suddenly crashed down on him — he contracted cold damage (shang han). And this was no ordinary case:

Headache as if the head would split — pain so intense it felt like his skull was tearing apart; a face burning red; a black tongue coating — dry black fur covering the tongue; restlessness and thirst — agitated inside, mouth parched beyond endurance; delirium — he began talking nonsense, babbling wildly; and most terrifying of all: his eyes did not close for seven days — he lay there, eyes wide open, unable to sleep at all. Meanwhile the old diarrhea grew worse too: dong xie ru zhu — gushing watery stools pouring out like a waterfall, far worse than before.

💬 Note from Doctor Luo: What is delirium? The patient’s fever has clouded his mind and he mutters nonsense — sometimes audible, sometimes not, as if possessed. You see exactly this in intensive care wards. And the black tongue coating: in this case it was dry black fur, which is a sign of extreme heat — a completely different thing from the moist black coating of cold-dampness.

At this point the family was close to collapse. Yu Jiqing’s father, Yu Yangshao, 82 years old, happened to be visiting at the home of Zhuang Lianzhi — a local gentleman and Miao Xiyong’s most devoted admirer, who helped compile Miao’s medical works. When the old man heard how ill his son was, his heart broke: this was his only son. If the boy died, how much longer could he himself, at this age, go on living? “If we go together, how could I bear it?”

An 82-year-old father, pleading at Miao Xiyong’s door

Zhuang Lianzhi hurriedly summoned Miao Xiyong. The moment Miao heard, he felt deep compassion — wei zhi ce ran, it was too tragic. Without a word he leapt onto his horse and galloped over.

He took the pulse: hong da — flooding and large. Blazing heat, raging thirst, heavy sweating, a big bounding pulse — the classic picture of exuberant heat in the yangming level.

💬 Note from Doctor Luo: What does a flooding, large pulse mean? It means the body is mobilizing every last resource to fight the pathogen — this is the yangming pattern, the state of high fever. In such a state there is only one direction: clear the heat.

Miao Xiyong prescribed Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) — Zhang Zhongjing’s famous formula and one Miao used again and again: raw gypsum leads, clearing heat; ginseng supports the upright qi; mai men dong (dwarf lilyturf root) and bamboo leaf nourish the fluids. But because the patient already had diarrhea, Miao worried that too much cold gypsum would make it worse — so he used only one liang (about 30 g) of gypsum.

The result? The medicine went down and nothing happened. The illness did not improve in the least.

The twist: friends urged warming tonics, Miao said “there is truth in that” — then took the pulse again, and it was still flooding

At this point, friends began offering advice. Someone said: this Mr. Yu su bu jin liang — he drinks, he eats meat, he indulges himself; his constitution is probably already hollowed out — most likely kidney deficiency. If he’s kidney-deficient and you cool him with raw gypsum, aren’t you pouring frost on a frozen plant? You should warm and tonify him with fu zi (aconite) and rou gui (cinnamon)!

Zhuang Lianzhi was torn and went to ask Miao Xiyong. Miao replied: “Cheng you shi li” — there is truth in what they say. The man has not lived carefully; kidney deficiency may well exist. But —

💬 Note from Doctor Luo: — and here comes the crucial sentence: “Judging from the pulse and symptoms I took just now, he is not deficient right now — he has exuberant yangming heat. Could his pulse have turned deficient in just two days? No. I’ll ride back and look again.”

Miao Xiyong mounted his horse and went back. He took the pulse again: still flooding and large, pounding hard under the fingers. Miao was categorical: “Ci shi yi tou gui fu, ji fa kuang deng wu, bi bu jiu yi!” — “If you give him cinnamon and aconite at this moment, he will burn into mania, climb onto the roof in frenzy — and then there will be no saving him!”

The direction stayed the same — Bamboo Leaf and Gypsum Decoction — but the gypsum was raised to two liang (about 60 g).

The key question: will two liang of gypsum make the diarrhea worse?

Zhuang Lianzhi worried again: once the cold gypsum goes down, won’t his belly run even more? Won’t the old diarrhea be doused with frost on top of snow?

Miao Xiyong’s answer is the most important passage in the entire case:

💬 Note from Doctor Luo: “What is stirring right now is the heat pathogen — this is a guest illness (ke bing), an acute external crisis. It is far too severe; if left untreated he will die immediately. So: ji ze zhi qi biao — in an acute condition, treat the branch. Treat the acute crisis first, because the harm it does is enormous. As for the diarrhea — that is an eight-year-old chronic disease; the body has long since ‘adapted’ to that state. It is a problem, yes, but not a fatal one. Huan ze zhi qi ben — in a chronic condition, treat the root: once the crisis has passed, we slowly adjust the chronic illness. When the two interfere with each other, the acute condition takes priority — use the gypsum to save the day now, and we will repair the damage afterward.”

One dose: he slept, and he was himself again

With two liang of gypsum, the Bamboo Leaf and Gypsum Decoction went down — one dose — and a miracle followed: ye wo sui mian — Yu Jiqing, whose eyes had not closed for seven days, fell asleep at night; ji xing ren shi — the man who had been babbling nonsense was clear-headed again!

A second dose — and all those fierce symptoms (headache, flushed face, high fever) melted away at once; bu shu ji huo ran — within a few doses the illness was completely gone and the entire crisis had been turned around.

💬 Note from Doctor Luo: Do you see it? One liang of gypsum did nothing; two liang cured him in a flash — the mystery of Chinese medicine is decided by dosage. When I say raw gypsum can be used in large doses, this is the road Miao Xiyong walked; later Doctor Zhang Xichun also built the dose up gradually, testing as he went, before he dared to use it boldly.

The illness was cured — but the diarrhea remained: in a chronic condition, treat the root

The acute crisis was over, but the eight-year diarrhea was still running. Miao Xiyong was in no hurry — slowly, steadily. He prescribed a regulating formula: Pi Shen Shuang Bu Wan (Spleen-Kidney Double Tonifying Pill) — tonifying the spleen and kidney as the foundation — plus huang lian (coptis) to clear the damp-heat inside, plus gan ge (kudzu root) and sheng ma (cimicifuga) to lift the qi upward — because after eight years of downward pouring, the qi was sinking, and it had to be raised. This was yi sha li zhi fa — applying the method for treating dysentery to this chronic diarrhea.

The result: bu yi yue, xie jing zhi — in less than a month, the eight-year diarrhea stopped! Ba zai chen ke, yi dan ruo shi. — Eight years of stubborn chronic illness, gone as if it had never been.

Yu Jiqing’s father, the 82-year-old Yu Yangshao, bowed low in gratitude, tears streaming: “Wei fu zi de sheng huan” — “That father and son can go home alive — this is all Mr. Miao’s gift!”

The core lesson: sort out what matters, and save the life-threatening problem first

The most essential takeaway of this case — one Doctor Luo emphasizes again and again — is: distinguish primary from secondary, interior from exterior, urgent from chronic — and above all, tell which is the branch (biao) and which is the root (ben).

💬 Note from Doctor Luo: When an acute external illness arrives, a chronic condition usually joins in the chaos, and patients describe everything as dire. The physician must judge: which of these is life-threatening, and which is not? The acute external illness does great harm — bring it under control first. The eight-year chronic diarrhea: the body has adapted to it, so adjust it slowly afterward. Treat the branch in acute conditions; treat the root in chronic ones — this is not empty talk, and the skill of balancing the two comes from experience. It is like using Pu Ji Xiao Du Yin (Universal Benefit Toxin-Dispersing Drink) for a swollen sore throat: when heat toxin is congested and raging, cold herbs like huang lian (coptis) and huang qin (skullcap) must be used, period. If a person with insufficient yang qi feels cold afterward, they can take Fu Zi Li Zhong Wan (Aconite Center-Regulating Pill) to restore warmth — but at that moment, with the heat toxin blocking the throat, there was no choice but to use the cold herbs.

Bonus: one liang ineffective, two liang effective — the dosage mystery of raw gypsum

Doctor Luo also told a true story here. When he was editor-in-chief of the Beijing TV health program Yangshengtang (Health Hall), an old professor from Tsinghua University wrote him a serious letter: gypsum’s active ingredient is mainly hydrous calcium sulfate. If you decoct one liang versus two liang, how much difference can the dissolved trace components really make? Why do you Chinese doctors say one liang does nothing and two liang works?

💬 Note from Doctor Luo: That old professor was extremely earnest. My answer was: hydrous calcium sulfate is only one of the active ingredients — some effective substances may simply not be analyzable by modern science yet; that’s possibility number one. Possibility two: a tiny change in composition can trigger a very different response in the human body. Look at a single Chinese herb — research teams have identified over 2,000 compounds in one plant. Which one is effective? Or do they work through mutual interaction? Or does the decoction combine with the gut microbiome to create new substances? The research teams walk straight into a maze. Cigarette smoke likewise contains more than 2,000 substances, and global tobacco companies have spent fortunes trying to find which ones benefit the brain — and still can’t. So with Chinese medicine, efficacy is decided by dosage — Miao Xiyong’s patient here: one liang ineffective, two liang effective. And that pregnant woman in the previous case: fifteen liang of raw gypsum consumed in a single day and night — mother and baby safe.

One more reminder: the Bamboo Leaf and Gypsum Decoction in this case contained ginseng. In the Ming dynasty, Northeast ginseng had already entered the market, and Miao Xiyong used genuine Northeast ginseng — not codonopsis (dang shen).

💬 Note from Doctor Luo: This is why raw gypsum can be used boldly — there must be ginseng supporting the upright qi. Clear the heat while protecting the healthy qi, and no harm will come of it. Both Miao Xiyong and, later, Doctor Zhang Xichun hammered on this point again and again.

What to take away

• Sort your priorities: in an acute febrile crisis, save the life first — treat the branch in acute conditions, the root in chronic ones. A chronic condition can wait; a blazing fever cannot.
• A flooding, large pulse with blazing heat means yangming excess — clear the heat; do not be talked into warming tonics by the patient’s “weak” history. Miao’s warning: give cinnamon and aconite here and the patient may burn into mania.
• When the dose is too small, nothing happens: one liang of gypsum failed, two liang turned the case around — dosage is where the efficacy of Chinese medicine is decided.
• Dry black tongue coating = extreme heat; moist black coating = cold-dampness — always read the texture, not just the color.
• Raw gypsum may be used in large doses — but always with ginseng to support the upright qi. That was Miao Xiyong’s iron rule, inherited by Doctor Zhang Xichun.
• Chronic diarrhea with sinking qi (after years of downward draining) needs both tonification (spleen and kidney) and lifting (kudzu root, cimicifuga) — Miao used the “dysentery method” and stopped eight years of diarrhea in under a month.

Arranged from Doctor Luo Dalun’s commentary on Doctor Miao Xiyong’s case records. Source: Xian Xing Zhai Yi Xue Guang Bi Ji (《先醒斋医学广笔记》).