Bloated Belly, Vomiting, Diarrhea, Stomach Pain and Feeling Cold? — When Spleen Yang Fails, Cold-Dampness Moves In

Search terms: bloated belly / vomiting and diarrhea / stomach pain / diarrhea / belly growing bigger in autumn / fear of cold and cold hands and feet / cold-induced diarrhea / Fu Zi Li Zhong Wan

Medical terms: Tai Yin syndrome (Greater Yin disease) · spleen yang deficiency · cold-dampness flourishing internally · spleen-stomach deficiency cold · acute gastroenteritis (cold type)

Opening: studying the Shang Han Lun — what you learn is not formulas, but a way of thinking

Today Doctor Luo Dalun continues his series on Doctor Xu Shuwei, the great Song-dynasty master of classical formulas, and how he treated illness with the formulas of the Shang Han Lun (Treatise on Cold Damage). Some friends hear the words “Shang Han Lun” and back away, afraid to study it — Doctor Luo says it is actually very simple: what we talk about is the reasoning of Chinese medicine.

💬 Note from Doctor Luo: The Shang Han Lun is the foundation of Chinese clinical medicine. Why? Because it establishes the method for you. How Chinese medicine looks at illness, how a formula should be formed — in the Shang Han Lun it is all written out clearly for you. So when you read the Shang Han Lun, you are not just memorizing formulas; more than anything, what are you learning? You are learning the way of thinking — the way of thinking about diagnosis, the way of thinking about regulating the body. Learning this is absolutely good for you.

Doctor Luo also sighs: everyone says we should protect our health and take it seriously, but not many people actually study seriously. When they get sick they want to find a famous doctor — “please, help me.” In reality, people who go around begging doctors like this find it very hard to cure their own illness: famous doctors are too few. You can search for two years, and you’ll find they are still asking for help online — the body hasn’t recovered, and it’s getting worse.

💬 Note from Doctor Luo: It is better to understand things yourself and regulate yourself a little — change your habits, use food therapy, moxibustion, foot baths, and so on. Many people recover this way. Health is in your own hands; the more you learn, the better off you are. Here’s an analogy: you offer a man a cow and he refuses, insisting on milk — which matters more, the cow or the milk? Of course the cow.

Who is the patient: a student taking exams (Cao Sheng)

Today’s case is a very interesting one — the patient is a Cao Sheng. What does “Cao Sheng” mean? It means a student preparing for the imperial examinations.

💬 Note from Doctor Luo: Doctor Xu Shuwei passed the imperial examinations quite late in life, so he spent his whole life dealing with examinations — as an examiner, and with examinees. And he treated patients throughout. This Cao Sheng was one such student.

This Cao Sheng first caught a cold illness — he initially contracted an external pathogen. Five or six days later, his belly felt distended and full, he vomited, and he could not eat — whatever went down came right back up. His body was still warm, his hands and feet hot — warm, not cold. And there was zi li — diarrhea, with pain in the belly.

💬 Note from Doctor Luo: Think about it — all his symptoms seem concentrated in the belly: distension and fullness, food coming back up, inability to eat, stomach pain, diarrhea — everything is about the belly. And the body is warm, the hands and feet hot — that is not a cold presentation.

What did the other doctors say? Some said stomach heat, some said huo luan

How did the other physicians see this illness? Some said it was excess of yang — yang qi is abundant, after all the hands and feet are quite hot and warm; they said “kang re xu yu wei zhong er tu” — the reason for the vomiting is that there is heat in the stomach, hot qi pushes upward, so he vomits.

💬 Note from Doctor Luo: Other doctors saw vomiting plus diarrhea and called it “huo luan” — note, this is not the infectious cholera; this is the ancient term for vomiting-and-diarrhea caused by spleen-stomach disharmony. What exactly was going on? Nobody could say. At this point Doctor Xu Shuwei was called in.

Doctor Xu Shuwei felt the pulse: thin and deep (xi er chen). Based on all this, he judged — this is Tai Yin syndrome.

💬 Note from Doctor Luo: “Tai Yin zhi wei bing” — this is what Zhang Zhongjing taught him. The Shang Han Lun states it clearly: when Tai Yin is diseased — “abdominal fullness and vomiting, inability to eat, diarrhea that grows worse, and frequent spontaneous abdominal pain” — the belly is full, things come back up, you can’t eat, the diarrhea gets worse and worse, and the belly often hurts on its own. That is Tai Yin syndrome. Doctor Xu Shuwei saying “Tai Yin syndrome” poses a question for us: you need to learn what Tai Yin syndrome is. That is the focus of today’s lesson.

What is Tai Yin syndrome? First, a review of the Six Channel differentiation

To understand Tai Yin syndrome, we first need to review Zhang Zhongjing’s Six Channel differentiation (liu jing bian zheng). Doctor Luo says that when Zhang Zhongjing talked about external pathogens, using cold as the example, the body has six layers of response:

First layer: Tai Yang syndrome — the body surface begins to resist; the enemy is first encountered, resistance begins. Tai Yang syndrome is very widespread; it is the earliest stage of illness, and the easiest to handle: at this point the body has just made contact with the enemy, and the balance of strength between self and enemy is all expressed at this layer. If the problem is resolved at Tai Yang, none of what follows will happen.

Second layer: Yang Ming syndrome — the body resists fiercely, begins mobilizing its forces, in an excited state, so there is often high fever. The foot Yang Ming stomach channel has gastrointestinal reactions, and there is the Yang Ming excess syndrome of the bowels (fu shi): the body mobilizes too much energy, heat is excessive, fluids are insufficient, and there is waste matter in the intestines. At this stage the resistance is fierce and upright qi is still relatively sufficient.

Third layer: Shao Yang syndrome — upright qi begins to weaken gradually, consumed quite heavily; resistance comes and goes, and it can easily turn into all-out defense and self-consumption. Shao Yang is the pivotal hinge in the middle — it can move toward resistance (a yang syndrome) or toward consumption of upright qi (a yin syndrome). Sometimes the supply of upright qi arrives, sometimes it doesn’t, and the result is alternating chills and fever (wang lai han re). Shao Yang is often connected with the liver and gallbladder, and later physicians treating internal miscellaneous diseases often use Shao Yang formulas to regulate liver-gallbladder conditions.

Fourth layer: Tai Yin syndrome — upright qi begins to be insufficient.

💬 Note from Doctor Luo: The Tai Yin syndrome Zhang Zhongjing described has its main symptoms all concentrated in the abdomen — this tells us it is related to the spleen, because the foot Tai Yin channel is the spleen channel. Zhang Zhongjing’s Six Channel differentiation, the zang-fu organ differentiation and the channel differentiation actually have internal connections — some people argue they are completely separate; my view is: there are internal connections. You should be able to look at them independently, and also see them as linked.

Why does Tai Yin manifest in the abdomen? The spleen is the granary official (cang lin zhi guan) — what does the spleen do? It manages the food storehouse. The stomach governs receiving; in the spleen, food is ripened and transformed, turned into absorbable nourishment, and then the finest essence of food is transported and distributed throughout the body, supplying grain and fodder to the fighting troops everywhere.

💬 Note from Doctor Luo: When your upright qi is sufficient, the grain and fodder are sufficient, the soldiers eat their fill, upright qi is strong, and you can resist pathogens. When you struggle against external pathogens, consuming and consuming, slowly the spleen qi becomes insufficient — the grain supply goes wrong, and the body sinks into a slump. The soldiers are hungry, there is no grain, the storehouse is nearly empty — at that point the body enters a cold state, a yin-cold state — not the state of full ammunition and grain where you fight hot and fierce, but a state of insufficient upright qi.

What exactly is Tai Yin syndrome? Spleen yang insufficiency, cold-dampness generated internally

So how do we define Tai Yin syndrome? Doctor Luo gives it in one sentence:

💬 Note from Doctor Luo: Tai Yin syndrome is spleen yang insufficiency and weakness caused by various factors — the body has already entered the cold state — and normally cold-dampness is generated internally. At this point, insufficiency of upright qi is the root.

Such a person — an ordinary healthy person would not reach this state; usually the spleen and stomach were already weak, upright qi insufficient, and when an external pathogen arrives (upright qi within, pathogens cannot invade — zheng qi cun nei, xie bu ke gan), but you are a little weak, so when the pathogen comes the body begins to fight excitedly, and then quickly spleen yang becomes insufficient. So basically this is a cold syndrome.

When cold-dampness occupies the middle jiao, what happens?

Bloated, full belly — especially this season, when the weather turns cold: people with spleen yang insufficiency who are about to fall into Tai Yin syndrome find their belly growing day by day. Strange — you haven’t eaten much, you’re even careful about drinking porridge, so why is the belly growing day by day? Yin-cold flourishing internally makes the belly big — unable to transform and transport, unable to distribute qi, cold congeals outside, and the belly grows bigger and bigger.
Inability to eat — the transforming-transporting function is degenerating; the spleen has no strength to transform and transport, so of course you can’t eat.
Pale tongue — the tongue color is pale, with lots of saliva on top; the mouth is bland, with no taste, and you especially want to eat something flavorful all the time.
No thirst, no desire for water — because water-dampness is especially abundant, water occupies the middle, and at this point you easily vomit — if a real cold attack comes and spleen yang deficiency gets worse, you vomit immediately, vomiting up food.
Down below: cold-dampness flourishing internally; when cold arrives, yang qi becomes even more insufficient and diarrhea starts pouring out — this kind of diarrhea comes with abdominal pain, and the pain continues even after the diarrhea passes — that is its characteristic (usually diarrhea brings some relief afterward; this one doesn’t — the pain stays after).

💬 Note from Doctor Luo: This kind of abdominal pain, I have deep feeling for it. When I was a child I often had this experience — my father and mother were quite old, in their thirties, when I was born; at that time we couldn’t get anything to eat, we were poor, and when I was born the nutrition was insufficient, my congenital endowment was weak; as a child even meat was hard to come by, and my body was a bit weak. In those years there were no cars for going out, no air conditioning in the house, clothes were simple — so I caught cold easily. I remember for a period of my childhood, every year there would be one or two bouts of stomach pain — oh, that pain; lying in bed was miserable, running to the toilet again and again. My mother was also a Chinese medicine doctor, but at that time she needled my Zusanli ST36 — actually moxibustion would have been better for me, but back then moxa sticks probably didn’t exist at all, you couldn’t buy them; actually giving me one Fu Zi Li Zhong Wan pill would have done it — what a pity I never got it. There was some ginger soup, but really I had to suffer half a day, sometimes a whole day, before it passed. That memory is very deep: that kind of pain is rolling back and forth in bed, a slow pain deep inside. Later I studied Chinese medicine and knew what this situation was; immediately I took Fu Zi Li Zhong Wan, and one use settled it.

The abdominal pain of Tai Yin syndrome is mostly accompanied by diarrhea, loose bowels; but sometimes it is constipation — the stool can’t come out, because the spleen’s transforming-transporting ability is already impaired.

There is also an important distinguishing point: most Tai Yin patients have cold hands and feet, cold all over; but some people have warm hands and feet with a cold abdomen — this is the special situation where cold pathogen entrenched in the middle jiao cuts the yang qi off from the outside. In Doctor Xu Shuwei’s case, Cao Sheng’s hands and feet were still warm.

💬 Note from Doctor Luo: Warm hands and feet — what does that tell us? He is not in Shao Yin syndrome — in Shao Yin’s jue ni (reversal cold of the extremities), the hands and feet go ice cold; his were still normal and warm, suggesting the special situation where cold pathogen sits in the middle jiao and isolates yang qi from the outside. Just know this; the main symptoms are all in the abdomen.

How was it treated? Doctor Xu Shuwei used Li Zhong Wan

How did Doctor Xu Shuwei treat it? “Yu Li Zhong Wan” — using Zhang Zhongjing’s method, he made pills the size of an egg yolk, five or six taken day and night; together with Wu Ji San (Raw Five Accumulations Powder) — which also warms yang, dispels dampness and slightly disperses external pathogens. The result: recovered in a few days.

This brings us to the important formula of today’s lesson — Li Zhong Wan.

💬 Note from Doctor Luo: Li Zhong Wan is the formula specially for treating Tai Yin syndrome. It is very simple — just four herbs: ren shen (ginseng), Bai Zhu (white atractylodes), gan jiang (dried ginger), and gan cao (licorice). Ginseng tonifies upright qi and original qi; Bai Zhu strengthens the spleen and drains dampness, removing water-dampness; licorice harmonizes the middle and the spleen and stomach. What is the most important here? It is gan jiang (dried ginger) — dried ginger warms the spleen, warms the spleen and stomach; it has a pungent, warming action, and its middle-warming power is very strong. If you add fu zi (prepared aconite) to this formula, warming it further, you get Fu Zi Li Zhong Wan (Aconite Center-Regulating Pill) — the very pill we use every day and that I often introduce to everyone. Who treats Tai Yin syndrome? You can treat it with Fu Zi Li Zhong Wan — the effect is very, very good. After Doctor Xu Shuwei gave it to him, you see — he was well within days.

Doctor Xu Shuwei adds a few more words: many doctors reduce every illness to just “yin syndrome” or “yang syndrome” — that binary division is right, but too crude. Zhang Zhongjing divided three yin and three yang, which is finer and better. With a case like this, if you only say “yin syndrome” you may not cure it — you need to know what syndrome it is (Tai Yin syndrome), where the disease is located, and how to regulate it. You must be clear.

💬 Note from Doctor Luo: The most important thing here is Li Zhong Wan. I think this formula works extremely well — ever since I recommended it, countless netizens know how to use it, and use it very well. Buy Tongrentang’s Fu Zi Li Zhong Wan — this is the egg-yolk-size pill Doctor Xu Shuwei talked about. Get the big honey pill, the best kind; when it hits your mouth, oh, that spiciness — chew it while drinking some warm water, wash it down, and your belly warms up immediately. Basically for this kind of cold-induced Tai Yin syndrome — cold-induced spleen yang deficiency, vomiting and diarrhea, stomach pain — one or two pills settle it. The effect is especially good.

Protecting yang qi: where does spleen yang come from? Fire generates earth, and the fire lives in the ming men of the kidneys

After the illness, Doctor Luo turns to the key point in today’s title — protecting yang qi. It is already cooling down in the northeast; the mornings are very cold, and for the month or two before the heating comes on, it is often the peak season for elderly people passing away.

💬 Note from Doctor Luo: Why? Because of cold. When you catch cold — if in daily life your spleen yang is insufficient, kidney yang insufficient, then heart yang will also be insufficient — the body is all connected; it is one system. And the breakthrough point is especially at spleen yang: once you lean cold, drink something cold in the morning, go out to exercise with the front of your coat hanging open and the cold wind blowing straight on your belly — then suddenly yin-cold flourishes internally. Mild cases: vomiting and diarrhea, stomach pain; severe cases: the heart has problems, and an elderly person is gone. So protection at this time is very important.

Protection starts from three levels:

First, nourish kidney yang in daily life. Where does spleen yang come from? The spleen belongs to earth — what generates earth? Fire generates earth. Where is the fire? In the ming men fire (the fire of the Gate of Life) in the kidneys — so the yang qi in the kidneys must be sufficient.

💬 Note from Doctor Luo: In daily life, warm and nourish kidney yang, especially people with insufficient yang. What to eat? Among the many patent medicines — Huan Shao Dan (Return to Youth Pill), Gui Fu Di Huang Wan (Cinnamon and Aconite Rehmannia Pill) and the like all work; take a little kidney-yang-warming medicine regularly. When kidney yang is sufficient, the little fire burns, and spleen yang becomes sufficient; when spleen yang is sufficient, heart yang is not weak — it’s one dragon, and heart yang becomes sufficient.

Second, when the weather turns cold, protect spleen yang carefully. Doctor Luo gives several concrete methods:

Stick a small Fu Zi Li Zhong Wan pill on the navel: take Tongrentang’s Fu Zi Li Zhong Wan, break off a small piece, roll it into a little pill, place it in the navel, and cover it with a band-aid — it warms spleen yang.
Use more yang-warming seasonings in cooking: more white pepper (white or black both work; white is the usual choice) — it lifts yang qi and dispels cold-dampness; add some chili, Sichuan pepper, star anise and cinnamon, and drink such soups to warm up.
Shen Gong Yuan Qi Dai (Miraculous Vital Qi Bag): there used to be a thing called the “Shen Gong Yuan Qi Dai” — a bag filled with various yang-warming herbs, stuck on the belly; the medicinal qi is absorbed through the skin and warms spleen yang.
Ding Gui Er Qi Tie (navel patch) also works.
Moxibustion on the navel (Shenque CV8): put a slice of ginger over the navel and moxa it — moxa Shenque CV8 regularly, it’s beneficial.

Third, pay attention to daily life — absolutely no cold food now: after the Start of Autumn (Li Qiu), be careful with cold dishes and watermelon, and iced beer is out of the question.

💬 Note from Doctor Luo: Once the weather turns cold — at the temperature we have in the northeast now — drinking iced beer is basically like drinking poison. I have a friend who is very interesting — he specializes in treating gout, and he never drinks beer except warmed in hot water: at the restaurant he lifts the cap, the waiter brings a bucket of hot water and warms his beer for him, and the waiters have never heard of such a thing. He says don’t worry, it won’t explode, and he does it every day — warming the beer hot and drinking it: the taste is better, and it doesn’t hurt your yang qi. In daily life, be careful not to let your spleen yang be injured.

There are also two reminders about yin-cold environments:

💬 Note from Doctor Luo: In this season when the weather is turning cold, people with insufficient yang should avoid certain yin-cold places — for example, funerals and cemeteries, empty palaces and ruins, forests after the sun goes down, and so on. I’m really not joking — some people come home with stomach pain and pouring diarrhea; at that point quickly light up a moxa cone on yourself, then take Fu Zi Li Zhong Wan down, and warm the yang promptly. It’s that some fragile people with insufficient upright qi are easily affected by changes in the outside world. And on very heavy overcast, foggy days — days when the whole sky is filled with gloomy mist — hold a slice of ginger in your mouth, drink some ginger-sugar paste; in short, get something warm, something yang-warming into you. These are all ways to protect spleen yang.

Finally, Doctor Luo translates Tai Yin syndrome into the language of modern medicine:

💬 Note from Doctor Luo: The Tai Yin syndrome Zhang Zhongjing described is, in reality, the situation where the body’s own upright qi is insufficient and, affected by external pathogens and various factors, gastrointestinal disturbance or even collapse appears first — especially, as we see today, it is related to the gut microbiota: the microbiota in the gut becomes disordered, because the whole environment changes and the gut flora changes too, which then causes the entire function to decline, and other organs and systems of the body follow into disorder. So why was this patient in Doctor Xu Shuwei’s case running a fever? We say it’s yin-cold, so shouldn’t everything be cold? Let me tell you: sometimes at this point the spleen and stomach are especially cold, heavy with cold-dampness and cold pathogen — but in fact the person has a fever. Go to the hospital with cold-type acute gastroenteritis: many people have a fever, and when you take their temperature it’s high. So you need to have this understanding.

Protecting yang qi and keeping spleen yang normal is an essential task for maintaining the health of the body.

💬 Note from Doctor Luo: Spleen and kidney yang deficiency are connected: kidney yang insufficiency causes spleen yang insufficiency, and spleen yang insufficiency causes kidney yang insufficiency — it is one system. If in daily life your yang qi is insufficient, if both kidney yang and spleen yang are deficient, and heart yang is also insufficient, then the whole body’s function will not be especially vigorous, and such people get sick more easily. So I hope everyone learns how to protect our yang qi and not let illness turn into Tai Yin syndrome.

Closing: if you should moxa, moxa; if you should warm the middle, use it

It is exactly this season when quite a lot of people with insufficient yang begin to have problems:

💬 Note from Doctor Luo: If you should moxa, moxa; if you should warm the middle, use it. In daily life, get some sun, sun your back, practice standing meditation (zhan zhuang), exercise — protect your spleen yang. Spleen yang is absolutely critical: when the spleen runs normally, the storehouse is full of ammunition, the body is normal, nourishment comes in properly — this is very important. If today you can get a clear understanding of Tai Yin syndrome — knowing that it is a kind of yang deficiency, a yin-cold flourishing caused by spleen yang insufficiency, with heavy dampness, producing various symptoms like vomiting and diarrhea and abdominal pain — then the goal is achieved. Tomorrow, we continue with Doctor Xu Shuwei’s stories of treating illness with the formulas of the Shang Han Lun.

What to take away

Tai Yin syndrome is spleen yang insufficiency from various causes — the body has entered a cold state with cold-dampness generated internally; insufficiency of upright qi is the root. Symptoms concentrate in the abdomen: bloating (the belly grows day by day), inability to eat, pale tongue with much saliva, bland tasteless mouth, no thirst, easy vomiting, diarrhea with pain that continues even after the diarrhea passes — and sometimes constipation instead.
Where does it sit in Zhang Zhongjing’s Six Channel differentiation? Tai Yang (surface resistance — earliest, easiest to resolve), Yang Ming (fierce resistance, high fever, bowel excess), Shao Yang (upright qi being consumed, alternating chills and fever, the pivotal channel tied to the liver and gallbladder), Tai Yin (upright qi insufficient, abdomen and spleen). Most Tai Yin patients have cold hands and feet; a special variant has warm hands and feet with a cold abdomen (cold pathogen isolating yang in the middle jiao — not Shao Yin syndrome).
The formula: Li Zhong Wan — just four herbs — ren shen (ginseng, tonifies upright qi), Bai Zhu (white atractylodes, strengthens the spleen and drains dampness), gan cao (licorice, harmonizes the middle), and gan jiang (dried ginger, warms the spleen and stomach — the most important one). Add fu zi (prepared aconite) and it becomes Fu Zi Li Zhong Wan (Aconite Center-Regulating Pill): for cold-induced spleen yang deficiency with vomiting, diarrhea and stomach pain, one or two of Tongrentang’s big honey pills, chewed with warm water, usually settles it.
Doctor Luo’s childhood story is a lesson in itself: cold stomach pain is miserable — his mother needled Zusanli ST36 (moxibustion would have been better); one Fu Zi Li Zhong Wan pill would have cured it instantly.
Protect yang qi on three levels: (1) nourish kidney yang daily — the spleen belongs to earth, fire generates earth, and the fire lives in the ming men fire of the kidneys (Huan Shao Dan, Gui Fu Di Huang Wan); (2) shield spleen yang when it turns cold — a small Fu Zi Li Zhong Wan pill on the navel, warming spices in cooking (white pepper, chili, Sichuan pepper, star anise, cinnamon), Shen Gong Yuan Qi Dai, Ding Gui Er Qi Tie, moxibustion on Shenque CV8; (3) watch your life habits — after the Start of Autumn no cold dishes, watermelon, or iced beer (iced beer is close to poison — one friend even warms his beer in hot water), avoid yin-cold places (funerals, cemeteries, empty ruins, forests after sunset), and hold a slice of ginger in the mouth on heavy foggy days.
In modern terms: Tai Yin syndrome is gastrointestinal disturbance or even collapse when upright qi is insufficient — especially tied to gut microbiota imbalance — and cold-type acute gastroenteritis really can come with fever.
Spleen-kidney yang deficiency is one connected system. People with insufficient yang get sick more easily — protecting yang qi and keeping spleen yang normal is a vital task for staying healthy.

Compiled from Doctor Luo Dalun’s lecture series on Doctor Xu Shuwei’s case records. The case is “Tai Yin Zheng” (The Tai Yin Case) from The Ninety Discussions on Cold Damage (Shang Han Jiu Shi Lun), written by Doctor Xu Shuwei around 1132.