Diarrhea

Diarrhea

For patients with blood deficiency and wasting, diarrhea is the most dangerous symptom, as it indicates that the spleen and stomach are severely damaged and unable to tolerate medication, with reduced food intake and declining stomach qi. For other illnesses causing diarrhea, using Shen Zhu Jiang Ling can be effective. However, in this case, ginger and atractylodes strengthen the stomach but harm the yin, leading to rapid onset of symptoms like shortness of breath and fever, eventually resulting in emaciation. On the other hand, using yin-nourishing herbs can exacerbate diarrhea because the spleen is already weakened, and further nourishing the yin only intensifies the diarrhea, potentially leading to collapse. For such cases, I have no better option than using Huangtu Tang as a temporary measure, though its effectiveness is uncertain.

The above discussion pertains to extreme cases of diarrhea caused by severe stomach qi depletion. If the diarrhea is not due to imminent stomach qi failure, treatment should be tailored to the specific condition, without prematurely declaring the patient hopeless, to avoid frightening them.

For damp diarrhea, characterized by watery stools, intestinal rumbling, and heaviness, but without abdominal pain, Weiling Tang is the primary treatment.

For wind diarrhea, stools are loose and may contain traces of blood; Bazhen Tang combined with Fenggegen, Danpi, Fangfeng, and Baizhi is recommended.

For cold diarrhea, there is sharp abdominal pain, rumbling sounds like thunder, and clear white diarrhea; Fuzi Lizhong Tang is the primary treatment, and Liu Junzi Tang combined with Jiang Fu can also be used.

For summer diarrhea, there is intense thirst, red urine, and sudden watery diarrhea. Yueju Wan combined with Zhuru, Fenggegen, Lianqiao, Cheqianzi, Niubangzi, Baishao, Huanglian, Biandou, Zhike, Houpu, Shengjiang, Huoxiang, and other ingredients is recommended.

For food-related diarrhea, where rice and grains are not properly digested, Xiangsha Liu Junzi Tang is used. This differs from acute diarrhea caused by excessive intake of water and food, which results in heat-driven urgency, requiring San Yi Chengqi Tang.

For food accumulation diarrhea, pain lessens after defecation, with a foul odor resembling rotten eggs, and acidic belching. Patients with blood deficiency are especially prone to this type of diarrhea, so Xiaoyao San or Xiao Chaihu Tang combined with ShanZha, ShenQu, MaiYa, and Laibozǐ are recommended. Yueju Wan and Pingwei San are also effective.

There is also hemorrhagic diarrhea and dysentery, which will be discussed separately in the section on hematochezia.

Additionally, there is renal diarrhea, occurring at dawn, also known as morning diarrhea. It is caused by excessive sexual desire and cold qi deficiency, so Si Junzi Tang combined with Shudi Huang, Gouqizi, Tusi Zi, Bajitian, Du Zhong, Po Gu Zi, Rou Dou Kou, Wu Wei Zi, and Shan Ju Yu is recommended. Alternatively, one pig kidney cooked with Gu Zi, Xiao Hui Xiang, and Qing Yan can also be consumed.

[Commentary] Due to blood loss, patients often experience chronic yin-blood deficiency. When combined with diarrhea, this condition is the most difficult to treat. Similar to general diarrhea, using ginseng, atractylodes, ginger, and licorice can further deplete yin, while using yin-nourishing herbs can worsen the diarrhea. In such cases, this article suggests using Huangtu Tang as a temporary measure. Of course, not every instance of blood-related diarrhea should be deemed incurable; mild cases can respond well to treatment, with therapies categorized according to damp, wind, cold, food-related, food accumulation, and dawn diarrhea.

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