Diarrhea

SYMPTOMS AND SIGNS: Diarrhea is a symptom which shows frequent and loose stools, or even watery stools, accompanied with abdominal pain and some other digestive symptoms. 

ETIOLOGY AND PATHOLOGY: The major causative factors for diarrhea are due to excessive dampness and the dysfunctions of spleen and stomach. It can occur year around, but mostly occurs in the summer and fall seasons. The affected organs are spleen and stomach, small and large intestine. The following are the pathogenic factors for diarrhea: 

(1). Exogenous factors, such as coldness, dampness, summer heat, and heat are often combined to obstruct the functions of spleen and stomach. Obstructed spleen and stomach loose their functions of transformation and transportation, and their ability to separate the pure and impure from food and drinks water and undigested' food go directly to the large intestine, causing diarrhea. 

(2). Excessive food, cold drinks, or alcohol damage the spleen and stomach, causing diarrhea. 

(3). Prolonged unhealthy emotions cause the stagnation of liver Qi; and the excessive liver Qi easily over-acts, attacking spleen and stomach since the liver normally controls the function of spleen according to the theory of Five Elements.

(4). The deficiency of spleen and stomach due to other chronic diseases or other factors. 

(5). Kidney Yang deficiency due to old age, or chronic diseases cause the spleen Yang deficiency. 

DIFFERENTIATIONS: 

1. Diarrhea due to Exogenous Factors: 

(1). Diarrhea due to the Cold-damp or Wind-cold: 

Indications: Watery diarrhea with abdominal pain and borborygmus, poor appetite, fullness in abdominal area, vomiting, or accompanied with fever, aversion to cold or wind, nasal congestion, headache, sore and pain of four limbs or back. White thin or white greasy tongue coating, thready, floating and slow pulse. 

Treatment and Formulas: Dispel wind-cold or damp-cold, eliminate the turbid factors by using fragrant and pungent herbs.

Products:

    • Huo Xiang Zheng Qi San (Agastache Formula, Item No. 2271): This is a very effective formula to treat diarrhea or vomiting due to exogenous damp-cold or wind cold, especially for the summer time. It is also applied to summer cold, heat stroke, headache, cough, anorexia. vomiting, chills, fevers. 
    • Wei Ling Tang (Magnolia and Hoelen Combination, Item No. 2135): It treats diarrhea with more internal dampness type. Symptoms show watery stools, abdominal ache, anorexia, fullness at chest or abdominal areas, heavy and fatigue of four limbs, greasy tongue coating. 

(2). Diarrhea due to Damp-Heat or Damp-Summer Heat: 

Indications: Diarrhea with yellowish feted stools. accompanied with abdominal pain, hot or burning sensation in the anus, restlessness, thirsty, scanty brownish urine, yellow and greasy tongue coating. rolling and rapid pulse. 

Treatment & Formulas: Clear the hear and eliminate: the damp factors. 

Products:

    • Ge Gen Huang Lian Huang Qin Tang (Pueraria, Coptis, and Scute Combination, Item No. , 2224): This is a very effective formula for diarrhea due to damp heat or damp-summer heat. It also applies to bacterial dysentery, amoebic dysentery, acute colitis. 
    • Liu He Tang (Cardamom Combination, Item No. 2049): It is a popular formula for gastrointestinal disorders due to the common cold or flu for four seasons or from summer heat.
    • Fu Xie Wan (Diarrhea Pill, or Traveler's Pill, Item No. 5018): This is a formula for diarrhea due food poisoning. 

2. Diarrhea due to Food Stagnated in Stomach and Intestine: 

Indications: Abdominal pain and borborygmus frequent fetid stool with indigestible food, feeling of release after defecating stool, oppression and
fullness at gastric or abdominal areas, acid regurgitation eructation with fetid odor, poor appetite, thick turbid tongue coating or thick greasy coating, rolling pulse.

Treatment & Formulas: To regulate the stagnated Qi and promote the digestion function of spleen stomach. 

Products:

    • Pao He Wan (Citrus & Crataegus Formula, ltem No.  2132): It is very popular formula for children or adult with various digestive disorders, especially for food stagnation type with poor appetite. 
    • Xiang Sha Liu Jun Zi Tang (Saussurea Cardamon Combination, Item No. 2125): This is a very good formula to treat indigestion due to spleen and stomach deficiency. 
    • Chi Pi Wan (Ginseng and Hawthorn Formula, Item No. 2193): This treats diarrhea due to spleen deficiency and indigestion. 

3. Diarrhea due to Excessive Liver Qi Attacking Spleen:

Indications: Always emotionally unstable, diarrhea and abdominal pain occurs when strong emotions show up, such as depression, anger, nervousness, eructation, poor or no appetite, light red tongue, wiry pulse.

Treatment & Formulas: Sedate and harmonize the liver,  tonify the spleen. 

Products:

    • Xiao Yao San (Tang-kuei and Bupleurum Formula, Item No. 2195): This sedates the liver, at the same time harmonizes the liver with spleen and stomach. It is applied to emotional instability, menstrual irregularity, leukorrhea, chronic endometritis, chronic hepatitis. 

4. Diarrhea due to the Deficiency of Spleen and Stomach: 

Indications: Loose or watery stool with indigestible bod, worse after taking fatty or oily food, poor appetite, fullness at gastric and abdominal areas, sallowish dull complexion, fatigue, pale tongue, white coating, thready and weak pulse. 

Treatment & Formulas: Promote the functions of leen and stomach thereby tonifing the Qi.

Products:

    • Shen Ling Bai Zhu San (Ginseng and Atractylodes Formula, Item No. 2173): This formula is very popularly used for diarrhea due to spleen deficiency from Qian Yi's book Xiao Er Yao Zheng Zhi Jue (Key to The Therapeutics of Children's Diseases) about 1032 -1113 AD. It is often applied to chronic gastroenteritis, gastroptosis, especially infantile diarrhea. 
    • Bu Zhong Yi Qi Tang (Ginseng and Astragalus Combination, Item No. 2225): It treats chronic diarrhea with symptoms of Qi dropping, such as shortness of breath, lazy speech, spontaneous sweating, prolapse of rectum or uterine, or hemorrhoids. 
    • Xiang Sha Liu Jun Zi Tang (Saussurea Cardamon Combination, Item No. 2125): It treats diarrhea with spleen deficiency as well as food stagnation. 
    • Chi Pi Wan (Ginseng and Hawthorn Formula, Item No. 2193): This promotes the function of spleen and stomach, helps digestion. It is very good for indigestion, nausea, colitis, and chronic diarrhea. 

5. Diarrhea Due to Kidney Yang Deficiency:

Indications: Abdominal pain, borborygmus and diarrhea once or several times each morning at dawn, after releasing the loose stool, abdominal pain is relieved. Other symptoms show cold limbs and body, sore and weak sensation at lumbar regions, pale tongue, white coating, deep and thready pulse. 

Treatment & Formulas: Tonify the kidney and spleen, stop diarrhea by using astringent herbs. 

Products:

    • Si Shen Wan is the formula to warm the kidney and spleen and it has anti-diuretic function as well. It contains the following ingredients: Nutmeg Seeds (Fleshy Cardamon): 22% 
    • Bu Gu Zi (Psoralea Semen, Item No. 1206): 44%
    • Wu Wei Zi (Schisandra Fructus, Item No. 1048): 22%
    • Wu Zhu Yu (Evodia Fructus, Item No. 1099): 11%
    • Wu Mei Wan (Mume Formula, Item No. 2291): This formula has a warming function, as well as an astrigent function. So it is very suitable for chronic diarrhea due to Yang deficiency at lower burner (kidney mostly), but heat at middle burner (Stomach). It is used for recurrent abdominal pain, gastric pain, jaundice and vomiting due to ascaris. 
    • Zhen Wu Tang (Vitality Combination, Item No. 2170): Warms the kidney Yang and has the diuretic function to treat the chronic diarrhea due to the kidney Yang deficiency. 

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