Diarrhea Before Every Exam? Many Digestive Problems Are “Worried” Into Being

💬 Note from Doctor Luo: Dear friends, hello everyone. Today we are back to chatting about Chinese medicine by voice. Today’s topic is called chou chang bai jie — “a worried gut tied in a hundred knots.” That phrase is fascinating — the ancient Chinese really knew how to put things. “Worried gut”: your emotions are causing problems in your intestines. “A hundred knots”: knot after knot after knot — a feeling of being all twisted up. Is that really how it works? Let’s see.

Opening: a child gets diarrhea before every exam

Recently a friend told Doctor Luo: “My child has exams coming up — there have been so many tests lately. Why does he get diarrhea every time there’s an exam, so bad he can hardly get into the examination hall?” Why does this happen?

💬 Note from Doctor Luo: This is a textbook case of intestinal disorder caused by emotional tension. Frequent diarrhea is actually the mild end of it. Sometimes emotional problems — tension, anxiety, and all the rest — cause the qi and blood in the gut to stagnate, and even more serious disease can follow. Many people today grow things in their intestines — all kinds of intestinal tumors and so on. The causes are many: it may be related to diet, it may be genetic — but emotional constraint is directly involved as well.

What does Chinese medicine say? Five words: gan mu heng ni ke pi tu

Why are the digestive organs so tightly connected to emotion? Chinese medicine has a wonderfully compact model.

💬 Note from Doctor Luo: What did the ancients call the spleen and stomach? The spleen and stomach belong to Earth — in the Five Elements, they are Earth. And what does the liver belong to? The liver belongs to Wood, and the liver governs free flow (zhu shu xie). Whenever your emotions are off and qi gets stuck, you get stagnant liver qi (gan qi yu jie). Once liver qi is constrained, the Wood cannot stretch out, and problems begin — Wood is supposed to grow upward, but when it cannot unfold, it starts to grow sideways. That is the famous phrase gan mu heng ni ke pi tu — the liver-wood runs sideways and overpowers the spleen-earth: it comes across and bullies the Earth. This is one of the best-known models in Chinese medicine, and what it says is simply: bad emotions cause digestive-system disorder. The ancients put it in a few characters, but those characters describe a major physiological and pathological reality.

Modern medicine confirms: emotion really does change the rhythm of the gut

Is this model credible? Modern medical research has found that yes — emotion shows up in the digestive system remarkably fast.

💬 Note from Doctor Luo: Research shows that anger and excitement put the parasympathetic nervous system into abnormal tension and trigger faster motility of the digestive tract — they change the rhythm of intestinal movement. That’s why some people burp when they’re angry, and can also get vomiting and nausea pushing upward, along with bloating and diarrhea — because the motility has speeded up. The opposite emotion — depression, feeling low and gloomy — weakens intestinal motility and reduces secretion: the mucous membrane of the whole digestive tract gets less blood supply and turns pale, producing indigestion, loss of appetite, constipation, and so on.

The trouble is, emotions are rarely single. Sometimes several mix together — a little depressed, a little simmering with anger, resentment inside — and then parts of the digestive tract speed up while other parts slow down. This unevenness makes food and food residue pile up in some places with rising pressure, and that kind of incoordination can trigger more serious disease.

The gut is the “fu brain”: it only listens to emotion, not to reason

Why is the gut so sensitive to emotion? The answer lies in its construction.

💬 Note from Doctor Luo: The digestive system, and the intestines especially, contain an enormous number of neurons — in the hundreds of millions, second only to the brain. In other words, the gut is basically an emotion-sensitive organ — the stomach is too, but the intestines are even more so. That’s why some scholars call the gut the “fu brain” — “the belly’s brain.” Our big brain is the seat of reason, but this “belly brain” does not obey reason; it is governed only by emotion. Tell it “slow down, relax” and it barely listens; but the moment you feel gloomy or angry, it reacts at once.

So scholars proposed the “brain-gut axis”: the brain and the gut are connected, with a two-way influence — when the brain’s mood changes, the gut changes along with it; and when the gut is abnormal, it feeds back to change the brain’s cognition and emotion centers. This is precisely the physiological basis of what Chinese medicine calls gan mu heng ni ke pi tu.

Stomach ulcers really are “scared” into being: the mouse experiment

The most typical link between emotion and digestive disease is the ulcer. Where do stomach ulcers come from? Doctor Luo tells the story of an animal experiment.

💬 Note from Doctor Luo: When a medicine is being developed, it is tested on mice. If the medicine treats stomach ulcers, you first have to give the mice stomach ulcers. How do you do that? — You frighten them: electric shocks, or putting them over water, about to fall in but never quite falling, frightening them every day. After a while, when they are dissected, their stomachs are full of ulcers. What does that tell us? Stress reactions, tension and anxiety create stomach ulcers. The same is true for people — a person who spends every day anxious about something that might happen, or who is overwhelmed by something that has happened, is prone to digestive ulcers, stomach ulcers above all.

A good formula for stomach ulcers: Huang Qi Jian Zhong Tang

So how do you treat a stomach ulcer? Doctor Luo offers the formula he uses most often.

💬 Note from Doctor Luo: For stomach ulcers I most often use Huang Qi Jian Zhong Tang (Astragalus Center-Fortifying Decoction). On one side this formula tonifies the spleen — everyone regards it as a spleen-tonifying formula. But look inside: there is bai shao (white peony). What is bai shao for? Softening the liver. So the formula tonifies the spleen and softens the liver at the same time — it is really a formula that harmonizes the liver and the spleen, and it is remarkably effective for digestive ulcers. The formula is simple: sheng huang qi (raw astragalus) to tonify qi; gui zhi (cinnamon twig) to soothe the liver and warm the channels; bai shao, used at twice the dose of gui zhi, to soften the liver; zhi gan cao (honey-fried licorice) to fortify the middle burner; and finally sheng jiang (fresh ginger) and da zao (red dates) to regulate the spleen and stomach. There are liver-softening ingredients and spleen-tonifying ingredients — that simple — yet its effect on stomach ulcers is excellent.

Ulcerative colitis: emotion “knots” itself onto the colon

Intestinal ulcers especially like to appear in the colon — ulcerative colitis.

💬 Note from Doctor Luo: Many colon problems have one root in diet — eating lots of meat and little green vegetables, for example — and another root in emotion. It is even fair to say that emotion knots itself onto the colon — this is very distinctive. Research shows: when you are worried and gloomy, the duodenal-colonic reflex is inhibited, intestinal motility decreases, and you get constipation — things pile up inside. When you are disappointed, frightened or a little resentful, the non-propulsive contractions of the sigmoid colon weaken while the propulsive movement of the large intestine strengthens — the lower end is not yet clear while the movement above increases, pressure builds throughout, and you get abdominal pain; once the lower end opens, you get diarrhea pouring out. That’s why some children get diarrhea before every exam — because they are afraid of the exam. And when you are extremely tense and angry, the descending colon contracts continuously and the intestinal lumen goes into spasm — the whole internal environment of the gut is changed.

Different moods produce abnormal movement in different parts of the colon at different stages — so bad emotion always “crashes” into some spot in the body, and the colon is one of the most typical spots.

💬 Note from Doctor Luo: Think about it — how much pressure is the colon under at times like that? Enormous. So when constipation and diarrhea alternate, what does that say? It says there is an ulcer in there — something is wrong inside. Persistent constipation or persistent diarrhea and so on are very often the effect of emotion on the gut, especially on the colon — and this is nothing to make light of.

Two roads, one destination: one looks at the whole, the other at the parts

Faced with emotion-driven gut problems, Chinese and Western medicine have ended up walking toward the same place.

💬 Note from Doctor Luo: Western medicine studies the fine details — what different emotions change in different parts of the colon. How does Chinese medicine study it? Chinese medicine holds that the liver governs free flow (gan zhu shu xie) — when emotions are bad, the liver channel becomes abnormal — and the liver channel’s pathway passes through the abdomen. So when Chinese medicine meets abdominal trouble — intestinal disorder, pain, diarrhea — it considers soothing the liver and regulating qi (shu gan li qi). You see, two roads, one destination: Chinese medicine considers the whole, Western medicine studies the local detail, and there is no real contradiction between them. The treatment is the same — Western medicine also tells you to adjust your emotions. In the end, the real solution in both traditions is to adjust the emotions.

So many people today have gut disease, and many have serious gut disease. Looking into the causes, emotional imbalance may be one of the most important factors of all. If this factor can be dealt with, it would do wonders for intestinal health. As for exactly how to adjust the emotions — Doctor Luo says that is a “big question,” and he will take it up next time.

💬 Note from Doctor Luo: Dear friends, today I introduced how Chinese and Western medicine each understand the way emotion disorders the gut. In the future we will introduce exactly how to adjust the emotions. If this factor can be resolved, it will be of great benefit to the health of our intestines. See you next time!

What to take away

Emotion is a direct cause of digestive trouble — from exam-day diarrhea in children to serious intestinal disease, the gut is one of the first places bad mood shows up.
The Chinese medicine model is simple and precise: the liver belongs to Wood and governs free flow; bad emotion constrains liver qi; the Wood then runs sideways and bullies the Spleen-Earth — gan mu heng ni ke pi tu — and the digestive system falls into disorder.
Modern medicine agrees: anger speeds up intestinal motility (belching, nausea, vomiting, bloating, diarrhea); depression slows it down (indigestion, poor appetite, constipation); mixed emotions create uneven, incoordinate movement that is even more damaging.
The gut is an “emotion organ”: hundreds of millions of neurons, second only to the brain — it obeys emotion, not reason, and the brain-gut axis runs both ways.
Stomach ulcers can literally be “scared” into being — the mouse experiment proves it — and Huang Qi Jian Zhong Tang (Astragalus Center-Fortifying Decoction), which tonifies the spleen and softens the liver together, is Doctor Luo’s go-to formula for them.
Different moods strike different parts of the colon; constipation alternating with diarrhea often means an ulcer is already inside.
Both traditions converge: the liver channel passes through the abdomen, so Chinese medicine soothes the liver and regulates qi — and both Chinese and Western medicine agree that the ultimate solution is to adjust the emotions.

Compiled from Doctor Luo Dalun’s lecture series (theory edition).