Uncontrollable Diarrhea for a Month, Wasting to Skin and Bones? Doctor Miao Xiyong Detected Hidden Heat and Cured Croton-Seed Poisoning Diarrhea

Patient’s search words: diarrhea that will not stop / passing whatever you eat / passing clear water / diarrhea even while asleep / anus burning like fire Medical terms: diarrhea (heat pattern) · croton-seed poisoning · undigested food in the stool (wan gu bu hua)

Opening: this case record was written by the patient himself

In the late Ming dynasty, the famous physician Doctor Miao Xiyong of the Jiangnan region took on an extraordinary fan — a local squire named Zhuang Lianzhi. How devoted was this Mr. Zhuang? He was the man who compiled and recorded Doctor Miao’s celebrated classic, the Xian Xing Zhai Yi Xue Guang Bi Ji (Extensive Medical Notes from the Studio of First Awakening).

Today’s case is recorded in unusual detail — because the person who wrote it down was the patient himself. And the reason Zhuang Lianzhi became so completely devoted to Doctor Miao began precisely with this illness that nearly killed him.

💬 Note from Doctor Luo: What makes this case interesting? It records with perfect clarity how the patient fell ill, how he suffered, and how he was brought back. Notice Zhuang Lianzhi’s attitude — the moment he met Miao Xiyong it was like meeting the idol of his life; whatever Miao Xiyong said, he believed completely. That trust later literally saved his life.

Who was the patient? Strong as an ox — then collapsed in the fourth month

Zhuang Lianzhi was ordinarily sturdy and robust; he ate with a huge appetite. But in the fourth month of that year, he was suddenly struck by diarrhea — and this bout of diarrhea nearly cost him his life.

💬 Note from Doctor Luo: If you are eating right now, skip this section — it is about diarrhea, and listening to it may put you off your food.

How bad was it? He passed whatever he ate, and even slept through the diarrhea

This was no ordinary diarrhea. With even a little porridge, vegetables, or a mouthful of medicine — the moment it touched his throat it felt like a needle: first a scorching sensation in the throat, then a burning pain running all the way down the digestive tract, the whole belly blazing and aching.

Then qi would rise in the abdomen — first from the left side, then from the right — churning and gurgling, and the moment it started he had to run to the latrine. Once there, out it came in a great flood, and his anus burned as if on fire.

Soon it began again — back and forth to the latrine, tormenting him completely. What came out was pure clear water, with a film of oil floating on top — nothing he ate was digested; it came out exactly as it went in. How severe was it? He could not control it even in his sleep — he was still passing it in his dreams.

💬 Note from Doctor Luo: Here is a bit of nursing advice for everyone. There are many patients with severe diarrhea whose anus burns like fire. Wiping with ordinary dry toilet paper only makes it hurt more. Use unscented wet wipes instead; if the household has a bidet-style toilet, even better — rinse clean and then pat dry, and the relief is enormous. Some patients ask me what to do when the pain is so bad they cannot even stand up — try this method first; it helps a great deal.

The doctors who came: some said heatstroke, some said cold — none helped

The family summoned many physicians. One said he had caught summer-heat; another said he had caught cold. All kinds of medicines were poured into him — and the result? Like pouring water on a stone — not the slightest response.

A month of this. Zhuang Lianzhi’s flesh was entirely gone; he was skin and bones, lying in bed waiting to die — it seemed the end was near.

His father had died early, and his old mother had raised this only son alone. Watching her one and only child waste away day by day, the mother wailed and cried out to heaven, wishing she could trade her own body for his — she would gladly have suffered in his place.

The turning point: at the end of summer, Doctor Miao Xiyong passed through Jintan

Heaven never seals off every road. That summer, Doctor Miao Xiyong happened to pass through Jintan and took up lodging there. The moment Zhuang Lianzhi heard, he was beside himself with excitement — Master Miao has come! Quickly, ask him to come and see the patient!

Doctor Miao felt the pulse: large and rapid — big and fast. In his heart he knew at once — fire and heat are blazing inside.

💬 Note from Doctor Luo: Doctor Miao later said of this case: I did not know where this illness came from, but your pulse told me that your body was burning with heat. This is how Chinese medicine works — you can treat an illness even without knowing its exact cause, because whatever reaction the body is having, the pulse and the tongue display it plainly.

The prescription: a bowl of ice-cold Coptis decoction

The direction was set: clear the heat. Doctor Miao wrote:

Chuan huang lian (Coptis) — clears heat; this was the leading herb. Bai shao yao (white peony root) — gathers the yin, eases acute pain. Ju hong (red tangerine peel) — moves the qi. Che qian zi (plantain seed) and bai fu ling (white poria) — promote urination, guiding the heat out through the urine instead of letting it leave through the stool. Bai bian dou (white hyacinth bean) — tonifies the spleen and stomach, stops diarrhea. Shi hu (dendrobium) — nourishes yin and generates fluids; after a month of diarrhea, the fluids were depleted. Zhi gan cao (honey-fried licorice) — harmonizes the whole formula.

The most distinctive part was the method of administration: after the medicine was decocted, it was chilled in well water until ice-cold, then a cup of boy’s urine (tong bian) was stirred in — boy’s urine is cooling and has the power to dissolve stasis, and Doctor Miao often used it as a guiding ingredient.

💬 Note from Doctor Luo: See how clear the logic is — when the pathogen is heat, use cold herbs, and he even iced the decoction to make it colder still. Boy’s urine dissolves stasis and guides the medicine downward — that was Miao Xiyong’s signature technique.

Doctor Miao also gave one solemn instruction: “Ci fang wu yi shi ren” — “Do not show this formula to anyone.” Especially not to other doctors.

💬 Note from Doctor Luo: Why? Because the formula was too simple! Another physician would look at it and laugh out loud: these few herbs, curing a month of violent diarrhea? And once he laughed, doubt would creep into your heart, and you might not dare drink it. So Doctor Miao said: ruo wei qu ming ji — if you want to live, believe in it, and drink it! You see — a great physician manages even the patient’s confidence.

The result: one dose like mint juice — the diarrhea stopped overnight

Zhuang Lianzhi trusted Doctor Miao completely — he might doubt other doctors, but not Miao Xiyong. He decocted the medicine at once and drank it.

What did it feel like? Like drinking mint juice — a faint coolness seeped into his chest, and within his belly “there was a coolness unlike any before”; suddenly everything was cool and refreshed.

One dose, and he slept through the night without a single bowel movement — a whole night with no diarrhea, a solid night’s sleep! After three doses, his stool had formed.

Even more wonderful was the change in his habits. For the month before, Zhuang Lianzhi found that any warm thing — warm medicine, warm porridge — made his qi surge upward and sent him running to the latrine; only cold drinks felt right, and the whole household had gotten used to it. But after those three doses, cold drinks suddenly made him feel nauseated and chilled — he hurried back to warm drinks, and only warm porridge felt normal again.

💬 Note from Doctor Luo: This is the “sign that the fire has retreated”! Before, there was fire in the belly; warm things poured oil on the flame, so he craved cold. Now the fire had retreated and the body returned to normal — of course it went back to its natural preferences. The body speaks for itself; the question is whether the doctor knows how to listen.

Aftercare, first formula: the diarrhea stopped — now support the upright qi

The fire had retreated. Doctor Miao said: now it is time to support the upright (zheng) qi. To the previous formula he added ren shen (ginseng), two qian and a half (about 7.5 g) — to tonify the primal qi; lian zi rou (lotus seed), forty grains — lotus seeds with the bitter heart removed, tonifying the spleen and holding the stool; hong qu (red yeast rice) and huang qi (astragalus) — red yeast rice strengthens the spleen and aids digestion, one of Doctor Miao’s experience herbs; a little sheng ma (cimicifuga rhizome) — to lift the sunken qi back up; and he halved the huang lian. This was taken for another five or six doses.

Doctor Miao was about to return to Changxing. Zhuang Lianzhi hurriedly asked for a formula he could take long-term. Doctor Miao said: this formula has already worked — keep taking it, but remove the sheng ma — no more need to lift the qi.

A setback: the diarrhea stopped, but the belly bloated painfully

A month or so later, Doctor Miao passed through Jintan again — the man was like a knight-errant, riding fast everywhere on his horse. Zhuang Lianzhi frowned the moment he saw him: Master, after you left I took that formula for over thirty doses. The diarrhea stopped, yes — but my spleen qi is bound up: the spleen and stomach feel tied in knots, I know neither hunger nor fullness, and after even a sip of hot tea or warm water, my belly swells up like a drum — it is unbearable!

Doctor Miao understood at once: after a great draining, the yin is much damaged — a month of severe diarrhea had wounded the yin aspect deeply. What was to be done? Tonic up slowly.

💬 Note from Doctor Luo: Doctor Miao issued a special warning: at this point, if an unskilled doctor saw the bloating and prescribed fragrant, drying herbs to move the qi — tangerine peel, cyperus and the like — it might feel a little better in the moment, but moving the qi consumes the upright qi! Once the primal qi is wounded, the belly bloats worse and worse, and slowly it turns into gu zhang (tympanites, drum-like distension) — truly hard to treat then. So bloating does not always call for moving the qi; you must find where the root lies.

The second formula: herb after herb, all tonics, made into pills

Doctor Miao wrote a new prescription — this time as pills, and every ingredient was a tonic:

Ren shen (ginseng), five liang — tonifies the primal qi; Doctor Miao loved ginseng for tonifying the qi of the heart and lungs. Bai shao yao (white peony root), six liang, and zhi gan cao (honey-fried licorice), one liang — six to one, together forming exactly Shao Yao Gan Cao Tang (Peony and Licorice Decoction) — sour and sweet generating yin, producing fluids. Wu wei zi (schisandra berry) — gathers and astringes the qi of the five organs. Mian huang qi (astragalus), five liang — tonifies qi. Shan zhu yu rou (cornus fruit), five liang — nourishes the yin of the heart and liver, tonifies essence, and is sour and astringent as well. Huai shan yao (Chinese yam), five liang — tonifies the lung, spleen and kidney, building the earth to generate fluids. Shu di huang (prepared rehmannia), eight liang — nourishes yin and fills the essence. Niu xi (achyranthes root) — strengthens the lower back and kidneys, tonifying the liver and kidney. Zi he che (human placenta), two liang — the placenta, greatly tonifying the primal qi.

💬 Note from Doctor Luo: Note these three — shan zhu yu, huai shan yao and shu di huang — they are exactly the “three tonics” of Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill)! Later, Doctor Zhang Xichun learned this heart-method: whenever he met a depleted, weak person, he put all three — prepared rehmannia, yam and cornus — on at once, tonifying all five organs together. Look at Miao Xiyong’s formula here: there is almost nothing for moving qi — it is entirely nourishing yin, tonifying qi, gathering and astringing, building up the essence of the five organs little by little. That is the proper treatment.

The pills were made with rice paste, taken twice a day before meals on an empty stomach. The cooling decoction was continued as well.

And Zhuang Lianzhi? He believed without a doubt and kept taking it for years. The result: his spleen and stomach gradually regained sensation — he knew hunger again, knew how much to eat — and his body grew plump and robust, fatter and healthier, completely restored.

From then on Zhuang Lianzhi had his own hard-won experience: whenever the spleen and stomach felt unwell, when there was diarrhea, or fire in the belly, he immediately used huang lian; when there was no fire, he dropped the huang lian — everything done exactly as Doctor Miao had taught him. That formula, his family treasured like a precious heirloom, calling it the gift that had raised him from the dead.

The truth revealed: after dismissing the concubines — croton-seed poisoning

Doctor Miao had also given one great rule of recuperation: abstain from sex for one full year. Zhuang Lianzhi obeyed Master Miao’s words to the letter — and went one step further: he dismissed all the concubines in his household.

And the moment they were gone, the truth came out. With no more jealousy and scheming among them, the women began to talk about the old days — and how Zhuang Lianzhi had fallen ill was finally clear: one jealous, competitive concubine had poisoned him with croton seeds (ba dou)! With all the favoritism, someone hated him enough to grind her teeth — so she poisoned him, to make him “unable to die, yet unable to live in peace.”

💬 Note from Doctor Luo: This is the marvel of the case — Doctor Miao never knew it was croton-seed poisoning to the very end; no one in the family knew either; the truth came out only years later. Yet he still cured the disease! Because he never chased after the cause — he simply read what the body was doing: your reaction is heat, so I clear your heat, and the body restores itself.

Croton seeds: never, ever to be taken lightly

Speaking of croton seeds, Doctor Luo has a special word of warning — this herb is genuinely dangerous:

💬 Note from Doctor Luo: Croton seed (ba dou) is a hot purgative; rhubarb (da huang) is a cold purgative — rhubarb is cooling in nature, used to purge when there is heat inside; croton seed is hot in nature, used when there is cold accumulation. But croton seed is highly toxic — the ancients said “ba dou da du,” great toxicity, not small! Once inside the body it corrodes the digestive tract lining and breaks down red blood cells; in severe cases it causes liver and kidney failure, and the person dies. That is why physicians of old, when using croton seed at all, had to process it strictly, and used it with extreme caution. The poisonings seen today are mostly children swallowing it by accident — nausea and vomiting, abdominal pain, violent diarrhea, bloody stool, cold extremities, dehydration and electrolyte disturbance, ending in coma and collapse. This is not a joke — playing a prank by putting croton seed in someone’s food can kill them.

How was croton-seed poisoning treated in the old days? The ancient physicians summed it up: huang lian juice, black-bean juice, aloe juice, han shui shi (calcium sulfate), ge gen juice — all cooling things, used to resolve its heat-toxin.

💬 Note from Doctor Luo: And what was the leading herb in Miao Xiyong’s formula? Coptis in large dose, three qian (about 9 g), decocted and chilled ice-cold in well water before drinking — exactly right! The ancient method for croton-seed poisoning was precisely coptis juice and cold water, taken cold.

The core heart-method: I do not know the cause, but I know what your body is doing

The case is told. Now Doctor Luo Dalun wants to show you the most valuable part — why did the previous doctors fail? Two reasons:

💬 Note from Doctor Luo: First, Jiangnan doctors used too little medicine. They had used huang lian too — but only a few fen, seven or eight fen (about 2–3 g); the dose was simply not enough. Miao Xiyong opened with three qian (9 g) as the base. Second — and this was the fatal one: after a month of diarrhea, everyone was shackled by the idea that “prolonged diarrhea must mean deficiency.” He had been draining for a month, passing clear water — it must be deficient-cold! But Miao Xiyong did not think that way: yes, the stool is clear water, but the pulse is large and rapid, and the tongue is red with a yellow coat — this is a picture of heat! Get cold and heat reversed, and the whole direction of treatment is reversed.

Now consider how modern medicine treats croton-seed poisoning: bowel lavage, to flush the poison out as much as possible; electrolyte replacement, to prevent imbalance — there is no targeted antidote for croton seed at all. And Chinese medicine? The ancient physician never made a fuss over the words “croton seed” — he simply looked at what reaction the poison had caused in the body, adjusted that reaction, and slowly supported the upright qi until the body healed itself.

💬 Note from Doctor Luo: This is the principle of Chinese medicine: whatever comes at you from outside, I regulate the reaction it causes inside you, and promote your own recovery. That is why Miao Xiyong could say, “shen er ming zhi, cun hu qi ren” — the miraculous clarity lies in the person. A physician must have steadfastness: once the pulse and signs are read correctly, do not waver. In this case, Miao Xiyong did not take a single wrong step.

Two traps — Doctor Miao stepped over both

Doctor Luo sums up: this case contains two great traps, and Miao Xiyong crossed both with ease:

💬 Note from Doctor Luo: The first trap — heat, treated with cold herbs. A parade of doctors had been fooled by “a month of diarrhea must be deficient-cold”; he saw clearly that it was heat, boldly used huang lian, and one dose worked. The second trap — extreme deficiency masquerading as excess. He was drained to skin and bones, the spleen and stomach at the extremity of deficiency — yet a sip of water bloated his belly like a drum, looking exactly like an excess pattern! This is where it is easiest to err: move the qi, guide digestion, attack and purge. And Miao Xiyong? Not a single qi-moving herb — all tonics, slowly tonics — until the spleen and stomach regained their qi and could transport again, and the bloating dissolved by itself. Zhuang Lianzhi’s little frame was skin and bones; one wrong step by a doctor and he might have been finished — so meeting a physician like Miao Xiyong was truly the luck of three lifetimes.

Ending: the devoted fan brought his idol to his own doorstep

After he recovered, how deep was Zhuang Lianzhi’s devotion to Doctor Miao Xiyong? He begged Miao Xiyong to move into a home near his own — and Doctor Miao later really did move there!

💬 Note from Doctor Luo: You see — when doctor and patient reach this point, it is heart given for heart. From then on Zhuang Lianzhi became Doctor Miao’s assistant, helping him organize case records and preserve his formulas — and the Xian Xing Zhai Yi Xue Guang Bi Ji we read today is the fruit of that partnership. So this case is not only a story of healing; it is a moving chapter in the history of Chinese medicine.

What to take away

1. Diarrhea that passes whatever you eat, in clear water with oil, for a month, is not “ordinary deficiency” — check the pulse and tongue. A large, rapid pulse with a red tongue and yellow coat is heat, no matter how long the diarrhea has lasted. Get cold and heat right first, and the treatment direction follows.
2. When the body shows heat, do not hesitate to use enough cooling medicine. Jiangnan doctors before Miao Xiyong used huang lian by the fen; Miao used three qian (9 g) as the base, chilled in well water — and one dose worked.
3. Extreme deficiency can masquerade as excess. Skin and bones, yet a sip of water bloats the belly like a drum — this is spleen qi at the extremity of deficiency. Do not move the qi or attack; tonify slowly. The bloating resolves when the spleen can transport again.
4. After a great draining, restore yin and support the upright qi. The formula of peony and licorice (sour-sweet generating yin), with ginseng, yam, cornus and prepared rehmannia — the three tonics of Liu Wei Di Huang Wan — slowly rebuilds the five organs. This is the proper treatment (zheng zhi).
5. Croton seeds are severely toxic and never to be used as a joke. The classical antidotes are cooling: huang lian juice, black-bean juice, aloe juice, han shui shi and ge gen juice — coptis was exactly the herb Miao Xiyong led with, chilled and taken cold.
6. If you have persistent diarrhea that will not stop, with burning pain and rapid pulse, consult a qualified practitioner of Chinese medicine near you.

Arranged from Doctor Luo Dalun’s commentary on Doctor Miao Xiyong’s case; the case comes from the Xian Xing Zhai Yi Xue Guang Bi Ji (Extensive Medical Notes from the Studio of First Awakening).