Chapter 26: Aconite Decoction for Regulating the Middle to Treat Diarrhea

“Oh, it’s like this. About two weeks ago, after our baby had some steamed egg with crab roe, he started having diarrhea. Several times a day, sometimes it was almost watery.”

“Then I bought some anti-inflammatory medicine from the pharmacy and gave it to him for two days, but it didn’t help much. Later, on another mother’s recommendation, I gave him probiotics for a few days. The frequency seemed to lessen a bit, but he still had diarrhea.”

“With no other choice, I took the baby to the children’s hospital. The doctor prescribed a different anti-inflammatory drug along with a box of Mamy Love. After two days, the symptoms eased somewhat, but didn’t fully clear up. His stools remained loose and unformed, and he was still going three or four times more than before he got sick.”

“It’s been almost half a month now and he hasn’t improved at all. I was really worried to death. Just last night, I ran into a neighbor from our compound who said you’re a very skilled doctor and could help, so I came here today.”

“Mm, Huaihuan’s mother, you’ve made the right choice to see a traditional Chinese medicine doctor. Don’t underestimate diarrhea as a minor illness; if it drags on too long, it can seriously damage the spleen and stomach, especially in children whose digestive systems haven’t fully developed yet. The impact is much greater,” Zhang Jing said seriously.

“Yes, yes, so please treat him carefully. We only have this one baby; nothing must go wrong. Have you already decided on the prescription?” the young mother asked anxiously.

Zhang Jing didn’t answer directly but began a detailed inquiry.

He followed the classic ten-question diagnostic method: first asking about chills and fever, then sweating, then head and body conditions, stool, appetite, chest symptoms, hearing and thirst, past illnesses, and cause of the disease.

Zhang Jing had this ten-question diagnostic chant firmly memorized, and he always remembered the advice from his mentor Li Yu: no matter how confident one is in diagnosing a condition, never neglect the importance of thorough inquiry.

Many overlooked details can be uncovered through careful questioning.

This is especially true in pediatrics, historically called the “mute branch” of medicine.

Many children can’t even speak properly, and even if they can, they often say confusing or unreliable things.

In such cases, the parents’ accounts are essential, which means more time must be devoted to the inquiry.

After about seven or eight minutes, the entire inquiry was finished.

Zhang Jing said earnestly, “You can rest assured; Huaihuan’s condition is not severe at the moment. But I must warn you, when children fall ill, you cannot take it lightly. Especially don’t just buy anti-inflammatory drugs from the pharmacy on your own assumptions. Remember, Western anti-inflammatory drugs are antibiotics, definitely not cure-alls.”

“That’s why the government is cracking down hard on antibiotic misuse. Because if they aren’t absolutely necessary, random use of antibiotics can cause serious harm to the body.”

“According to traditional Chinese medicine theory, antibiotics correspond to heat-clearing and detoxifying herbs, which have a bitter and cold nature. If a person’s constitution is already weak and cold, taking too much of these bitter cold medicines will only add fuel to the fire—adding cold to cold. And excessive cold damages yang.”

“When yang qi is impaired—the yang being responsible for warming, moving, defending, consolidating, and transforming physiological functions—it declines. In Huaihuan’s case, this shows as cold blocking the middle burner, causing persistent diarrhea. In other words, his yang qi’s ability to consolidate is suppressed.”

“What should we do then?” The young mother grew anxious.

“Once the cause of the condition is identified, it’s not difficult. Since the middle burner’s spleen and stomach have cold dampness, we simply need to add some fire inside the body to warm the yang and transform the dampness.”

“Add fire inside the stomach?” The young mother looked terrified.

Zhang Jing smiled faintly and shook his head, continuing, “Not real fire, it means warming the yang.”

“Alright, I was just overthinking,” the young mother said awkwardly with a smile.

“Good. I’ll write out a prescription now, just one dose for starters. After his stools return to normal, you can come back for some tonic herbs.”

“One dose means one day?” she asked.

“Yes.”

“That doesn’t seem right, Doctor Zhang. The diarrhea has lasted so long; how can one day of medicine be enough?” she questioned again.

Zhang Jing responded confidently, “As I said, your child’s condition is not severe. One dose is enough to stop the diarrhea. However, from his pulse, I can tell he has a deficient spleen constitution, so it’s best to have some follow-up tonifying treatment, which will greatly benefit his growth and development.”

In fact, Zhang Jing could have prescribed the tonic herbs immediately, but considering the young mother’s skepticism, he decided it would be more prudent to wait until the diarrhea was cured before starting the tonic treatment.

After all, only tangible effectiveness can fully earn a patient’s trust!

This statement hit the young mother’s heart perfectly.

“Alright, I’ll trust you, Doctor Zhang,” she said happily.

Zhang Jing then began recording the case on the computer and preparing the prescription.

Originally, he wanted to follow Li Yu’s example by using handwritten prescriptions and personally decocting the herbs for little Huaihuan.

But given the current circumstances, the timing was clearly not right.

The clinic did have printed prescription forms, but they required input into the computer for billing, and Guicui might find that troublesome.

As for traditional decoction equipment, he wasn’t yet in a position to suggest purchasing more since a decoction machine was already available.

So for now, he had to make do with what was at hand.

Zhang Jing didn’t use a smartphone or browse the internet, but that didn’t mean he couldn’t operate a computer.

On the contrary, since computer studies were compulsory in university, he was quite proficient—especially in Wubi typing, surpassing the class average.

In no time, Zhang Jing finished entering Huaihuan’s medical record.

“Patient: male, two and a half years old, diarrhea for nearly half a month, three to four times daily, previously treated with antibiotics, probiotics, and Mamy Love. Present: fatigue, slight poor appetite, normal urination. Examination: pale tongue body, greasy coating in the middle and rear, weak and slightly slippery pulse.”

“Diagnosis: Taiyin-Shaoyin combined syndrome (cold-damp retention). Prescription: Fuzi Lizhong Decoction.”

“Herbs: prepared aconite 3g, raw and dried ginseng 3g, dried ginger 3g, roasted licorice 3g, stir-fried white atractylodes 6g. One dose, decocted warm.”

He also neatly copied the same information into the medical record book in block letters.

This was a requirement from higher supervisory authorities—no matter if electronic records were used, a paper copy had to be given to the patient.

Of course, in most hospitals, electronic medical records are printed out.

Small clinics usually don’t support this feature or lack convenient printers.

Strictly speaking, Fuzi Lizhong Decoction isn’t found in the Treatise on Febrile Diseases.

Zhang Jing recalled that this formula was recorded in the university textbook “Formula Science,” originating from the Song dynasty physician Chen Wuze’s “Discussion on Three Causes and One Disease,” named Fuzi Lizhong Decoction.

However, he knew better that Fuzi Lizhong Decoction was derived from Lizhong Pill mentioned in the Treatise on Febrile Diseases.

The original Lizhong Pill formula: ginseng three liang, dried ginger three liang, roasted licorice three liang, white atractylodes three liang.

Usage: pound and sift the four herbs, mix with honey into pills the size of a chicken egg yolk, dissolve one pill in several measures of boiling water, crush and take warm three to four times daily, two doses at night.

If the abdomen is not hot, increase to three to four pills, but it’s not as effective as the decoction.

For decoction, cut the four herbs according to two liang each, use eight sheng of water, boil down to three sheng, strain, warm and take one sheng three times a day.

If there is a fullness above the navel, indicating kidney qi movement, remove atractylodes and add four liang cinnamon bark.

If vomiting is frequent, remove atractylodes and add three liang fresh ginger.

If diarrhea is frequent, use atractylodes again.

If palpitations occur, add two liang poria.

If thirsty and craving water, add atractylodes, making the total four and a half liang.

If abdominal pain, add ginseng to total four and a half liang.

If cold, add dried ginger to total four and a half liang.

If abdominal distention, remove atractylodes and add one piece of prepared aconite.

After taking the decoction, wait a while then drink about one sheng of warm porridge, slightly warm yourself but avoid uncovering or removing clothing.

…

From the modifications of Lizhong Pill in the Treatise on Febrile Diseases, it’s clear that adding prepared aconite to Lizhong formula was known, though not named as an independent prescription.

After completing the prescription, Zhang Jing explained the decoction method.

Pour the herbs into a ceramic medicine pot, add about 300 ml of water to soak for 15–20 minutes. Do not discard the soaking water.

Place the pot on a gas stove, bring to a boil over high heat, then lower to the smallest flame and simmer for about 15 minutes.

Pour out the decoction, about 100 ml, strain out the dregs.

Take warm, about 30 ml per dose.

After explaining, the young mother still had some worries.

“What if the child refuses to drink because the medicine tastes bitter?”

“You can add some rock sugar in moderation, but not too much.”

“All right, then no worries. Thank you so much, Doctor Zhang!”

“No need to thank me; this is just part of a doctor’s duty. If anything happens, feel free to contact me anytime. I’ll give you my phone number.”

“Ah? That’s so embarrassing! Thank you so much!” the young mother said excitedly.

It was no wonder; almost no one who goes to a hospital ever sees doctors offer their contact information proactively.

Even if you insist, they usually won’t give it out.

The reason being, doctors have private time and shouldn’t be disturbed.

Or you could interpret the underlying message as: medical treatment is a special transaction, no after-sales service provided.