Diarrhea

 Western medicine

 Crohn’s, IBS, GI inflammation.  

This condition may be involved in acute and chronic enteritis, indigestion, intestinal parasitic diseases, diseases of the pancreas, liver and biliary tract, endocrine and metabolic disorders, and neurotic troubles.

Oriental Medicine

Diarrhea refers to abnormal frequency and liquidity of fecal discharges. It is usually due to disorders of the spleen, stomach, large and small intestines. In light of the manifestations of the disease and the course, it is clinically divided into acute and chronic. The former is mostly caused by indigestion due to excessive eating or improper diet and attack of external cold dampness, leading to dysfunction in transmission of intestinal contents, or caused by invasion of damp heat in summer or autumn: the latter is caused by deficiency of the spleen and stomach, leading to failure in transportation and transformation.

It is essential to distinguish diarrhea and dysentery.

Etiology and Pathogenesis

The causative factors are functional disturbance of the spleen and stomach is inevitably involved pathogenetically. The stomach dominates receiving food while the spleen dominates transportation and transformation. In case the spleen and stomach are diseased, the normal digestion and absorption of food is impaired, leading to mixing of food essence and wastes. When they descend through the large intestine, diarrhea occurs.

As to the factors of diarrhea due to functional disturbance of the spleen and stomach, there are many as follows.

Diarrhea may be caused by the six exogenous pathogenic factors, among which mostly by cold, dampness and summer heat. The spleen is in preference to dryness but dislikes dampness, which usually causes diarrhea. Besides the superficial portion of the body and the lung, the stomach and intestines may be affected by the pathogenic cold or summer heat, resulting in diarrhea.

In the latter case, however, the diarrhea is also often related to dampness.

Excessive intake of food, particularly greasy food, leading to impairment of the stomach and spleen in transportation and transformation, or eating of raw, cold, dirty food, injuring the spleen and stomach, all bring about diarrhea.

Diarrhea may also be caused by weakened function of the spleen and stomach due to irregular daily life or other factors. Since the spleen has the function in transformation and transportation, diarrhea may occur if this function is affected.

The spleen yang is closely related to the kidney yang. The fire of Mingmen (Vital gate) (kidney yang) may help the spleen and stomach to digest and transform food into chyme. In case the kidney yang is weak, the spleen yang is weak as well and fails to digest and transform food into chyme, thus diarrhea occurs. Zhang Jingyue said: The kidney is the passgate of the stomach and makes the urinogenital orifice and the anus as its openings. The passing of both urine and stool is dominated by the kidney. Now the kidney yang is weak, leading to decline of Mingmen (Vital gate) fire, and excess of cold: therefore, diarrhea occurs.

Main manifestations: external pathogenic invasion impairs large intestine function, Watery diarrhea, abdominal pain and borborygmi, chilliness which responds to warmth, absence of thirst, poor appetite, aversion to cold, T- white slippery coat, P- soft or tense

Analysis: When the cold - dampness attacks the stomach and the intestines, disturbing the function of the spleen in sending food essence and water upward and that of the stomach in sending the contents downward, the food essence and the waste can not be separated, moving downward together through the large intestine, so watery diarrhea with borborygmi occurs. If the qi of the stomach and intestines is stagnated, abdominal pain appears. Cold - dampness is a combination of yin pathogenic factors and easy to damage yang qi. When yang qi is blocked, chilliness which responds to warmth and absence of thirst occur. Pale tongue, white tongue coating, and deep, slow pulse are the signs of excess of internal cold.

P/T – expel cold, transform Damp, harmonize mid Jiao

1. Acupunctre – neutral, moxa, hand and foot yangming, LI 4, RN 12, ST 25, 37 (LI low he-sea)
   1. more pain – moxa RN 8
2. Diarrhea Formulas Due To Cold
   1. Hou Xiang Zheng Qi San (travellers Formula)
   2. Bao Ji Wan
   3. Wei Ling Tang (stomach flu)
   4. Xiao Chai Hu Tang with Ping Wei San = Chai Pink Tang

Main manifestations: Abdominal pain relieved after bowel movements, borborygmi, diarrhea with fetid stools, epigastric and abdominal fullness and distension, belching, anorexia, thick filthy tongue coating, rolling, rapid or deep, string - taut pulse.

Analysis: Retention of food impairs the stomach function in sending its contents downwards and the transmitting function of the intestines, so there are epigastric and abdominal fullness and distension, abdominal pain and borborygmi. After the undigested food turns putrid, diarrhea with offensive fetid stools, belching and anorexia occur. After the wastes are discharged, abdominal pain relieves. Thick filthy tongue coating, and rolling, rapid or deep, string - taut pulse are the signs of retention of food.

P/T – promote digestion

Acupuncture – Shu, Mu, RN 12, LR 13, BL 20, 21, ST 36, RN 10, RN 21 & Li Nei Ting (under ST 44)

IBS, emotions induce diarrhea, pain, borborygmi, T- red, thin coat, P- wiry

P/T – soothe Liver

Acupuncture – foot jueyin, yangming, BL 18, LR 14, 3, GB 34 (pain), BL 20, RN 12, ST 25, 36

Main manifestations: Diarrhea with abdominal pain, acute cramping then must get to toilet immediately, yellow, hot and fetid stools, burning sensation in the anus, scanty urine, or accompanied by general feverish feeling, thirst, may have fever, T- red, yellow greasy coat, P- soft or slippery and rapid

Analysis: When the intestines and stomach are attacked by the damp heat in summer or autumn, the transmitting and transformation function is disturbed, and diarrhea appears. If the damp heat pours down, diarrhea happens as soon as the abdominal pain is brought about. If the heat stays in the intestines, there appear diarrhea with yellow, hot and fetid stools and burning sensation in the anus. When excessive heat evaporates the dampness, there are scanty urine, general feverish feeling and thirst. Yellow, sticky tongue coating, and rolling, rapid pulse are the signs of excess of damp heat.

P/T – clear Heat, eliminate Damp, regulate Large Intestine

1. Acupuncture: LI 4 & ST 44 (clear Heat), RN 12, ST 25, 36, 37
   1. burning anus – bleed BL 40
   2. fever – LI 11 & DU 14
   3. Heat – Jin Jin & Yu Yue
2. Herbal Therapy
   1. Ge Gen Huang Qin Huan Lian Tang
   2. Bai Tou Weng Tang (LU/LI/SP)
   3. Shao Yao Tang 

Main manifestations: chronic loose soft stool with undigested food, anorexia, epigastric distress after eating, sallow complexion, sensitive digestive system, fatigue, lassitude, T- pale, teeth-marks, greasy coat, P- thin

Analysis: In case of weakness of the spleen and stomach, the spleen qi fails to ascend and digestion is impaired: therefore, loose stool with undigested food appears. As the weakened spleen fails to digest and transport the food, anorexia and epigastric distress after eating occur. Persistent diarrhoea further weakens the spleen and stomach, affecting the production of food essence and formation of qi and blood, and thus resulting in the sallow complexion and lassitude. Pale tongue, white tongue coating, and thready, forceless pulse are the signs of weakness of the spleen and stomach.

Method: The points of the Spleen Meridian and some other points concerned are selected as the principal points with the reinforcing method and moxibustion to strengthen the function of the spleen and stop diarrhea.

Acupuncture Prescription:

[BL20 – LR13 – SP3 – RN12 – ST36]
tonify, moxa, Ren foot taiyin, Shu, RN 12, ST 25, BL 21, 25, RN 9 & SP 6 (damp)

Explanation: BL20, the Back-shu point of the spleen, LR13, the Front-mu point of the spleen, SP3, the Yuan point of the Spleen Meridian, in combination with RN12, the Front-mu point of the stomach, and ST36, the He-sea point of the Stomach Meridian, are needled with moxibustion to invigorate the spleen yang, strengthen the function of transportation and transformation and stop diarrhea.

Main manifestations: Pain below the umbilicus, borborygmi and diarrhea usually occurring at dawn, relieved after bowel movements, and aggravated by cold, abdominal distension sometimes, cold lower extremities like warmth and pressure, T- pale, swollen, teeth-marks, white coat, P- deep thin weak

Analysis: Pain below the umbilicus and diarrhea with borborygmi at dawn are due to hypoactivity of the kidney yang and the declined Mingmen fire. Yin should be at maximum in case yang qi is not restored. The stomach fails to hold its contents because of the declined Mingmen fire, thus diarrhea results. Abdominal aversion to cold, and sometimes distension, cold lower, extremities, pale tongue, white tongue coating, deep, forceless pulse are the signs of deficiency of the yang qi in the spleen and stomach.

Method: The points of the Kidney Meridian, Ren and Du Meridians are selected as the principal points with the reinforcing method and moxibustion to warm and reinforce the kidney yang.P/T – astringe and warm intestines

Acupuncture Prescription:

[BL23 – BL20 – DU4 – RN4 – KI3 – ST36]
tonify, moxa, BL 23 & RN 4, BL 20, LR 13, ST 36, RN 12 & ST 25 (regulate intestines), DU 4 & RN 8 (needle and moxa)

Explanation: BL23 is the Back-shu point of the kidney and LI3 is the Yuan point of the Kidney Meridian. Needling to these two points with the reinforcing method can warm the kidney yang and invigorate the kidney qi. Moxibustion to DU4 and RN4 is able to reinforce the Mingmen fire and strengthen the kidney yang so as to warm the spleen and kidney and promote digestion. This is known as a treatment of the root cause. BL20 and ST36 are used to strengthen the spleen function and stop diarrhea.

auricular – SI, LI, ST, SP, LR, KI, sympathetic, shenmen, rectum
acute – strong stimulation, chronic – mild stimulation
7 star – T8-lower sacrum area, On lower abdomen on the SP, ST and Ren meridians
injection – B1 & B12 combo, ST 25, 36, 37, BL 25