Diarrhea is characterized by abnormal frequency and liquidity of fecal discharges. It is frequently seen in infants and can threaten the life of the patient.

Etiology and Pathogenesis

Exogenous pathogenic factors, indigestion, hypofunction of the spleen and stomach and deficiency-yang are the common causes of infantile diarrhea. That "the spleen is innately hypofunctioning" is the physiological characteristic responsible for the pathogenic basis of infantile diarrhea. Since the spleen and stomach of infants are not well developed, their digestive function is weakened. Whenever the pathogenic factors, either exogenous or endogenous in origin, affect the infant, the digestive function of the spleen and stomach is liable to be deranged and diarrhea results. Owing to the weakness of their internal organs, in the serious or chronic cases of infantile diarrhea, yin and yang or both may be easily impaired and complications occur. Moreover chronic diarrhea may develop into infantile malnutrition and chronic infantile convulsions.

Syndrome Differentiation and Therapeutic Principles

A. Syndrome differentiation Infantile diarrhea may be differentiated as either heat or cold, and either asthenia or sthenia syndromes according to the following characteristics:

(a) The length of course: A case with a short course usually manifests itself as a sthenia-syndrome, while a chronic case as an asthenia-syndrome or an asthenia-syndrome accompanied by a sthenia-syndrome.

(b) Abdominal pain: A case with dull pain relievable by pressure and warmth is attributed to cold and asthenia-syndrome, while that with severe pain relievable by cold and tenderness is attributed to heat and sthenia-syndrome. A paroxysmal pain accompanied by urgency of defecation and relieved after fecal discharge indicates a case of indigestion, and a colicky pain with severe diarrhea and thirst denotes a case with dampness-heat changing to fire.

(c) Stool: A yellow-brown and foul stool is attributed to heat-syndrome, a stool containing undigested food or milky clots to sthenia-syndrome, a watery and yellowish stool to cold-syndrome, while a case with lienteric diarrhea after eating or sustained frequent diarrhea to asthenia-syndrome.

(d) Tongue picture: A white, greasy tongue coating indicates the retention of dampness, a red tongue with yellow coating shows the presence of heat, a corpulent tongue with teeth marks on its margin denotes yang-deficiency, and a crimson, dry tongue indicates yin-impairment.

B. Therapeutic principles The therapy for regulating the function of the spleen is the basic principle, and others may be supplemented according to the different syndromes. For example, the therapy of dispelling wind should be employed for cases with wind as the predominant syndrome, that of warming middle-jiao for those with a predominant cold-syndrome, tonifying therapy for asthenia-syndrome, that of promoting digestion for dyspepsia, that of nourishing yin with sour-sweet drugs for serious cases with impairment of yin, and that of recuperating the depleted yang for cases with exhaustion of yang.

Classification and Treatment

A. Diarrhea due to dyspepsia

Manifestations: Discharge of foul stools containing undigested foul or milky clots, abdominal pain and distention relieved after bowel movement, halitosis, poor appetite, eructation, acid regurgitation, nausea, thick greasy or yellowish tongue coating and smooth pulse.

Therapeutic principles: Promote digestion.

Prescription: The Modification of Pill for Promoting Digestion

Fructus Crataegi 10 g
Massa Fermentata Medicinalis 10 g
Fructus Hordei Germinatus 10 g
Pericarpium Citri Reticulatae 5 g
Semen Raphani 5 g
Fructus Forsythiae 10 g
Poria 10 g
 

Remarks: Add Caulis Bambusae in Taeniam (10 g) and Herba Agastachis (6 g) for cases with vomiting. Add Radix Aucklandiae (3 g) and Cortex Magnoliae Officinalis (5 g) for those with marked abdominal distention. Add Fructus Aurantii Immaturus (6 g) and Radix et Rhizoma (6 g) for older children with marked retention of food.

B. Diarrhea of wind-cold type

Manifestations: Discharge of thin and frothy stools, abdominal pain, increased borborygmus or fever, anhidrosis and chilliness, white and moist tongue coating and floating and tense pulse.

Therapeutic principles: Dispel wind-cold.

Prescription: The Modification of Agastachis Powder for Restoring Healthy Qi

Herba Agastachis 10 g
Folium Perillae 6 g
Poria 10 g
Rhizoma Pinelliae 5 g
Pericarpium Citri Reticulatae 5 g
Cortex Magnoliae Officinalis 5 g
Pericarpium Arecae 10 g
Radix Angelicae Dahuricae 3 g
Radix Platycodi 3 g
 

Remarks: Add Herba Schizonepetae (6 g) and Radix Ledebouriellae (3 g) for cases with high fever and marked chilliness. Add Radix Aucklandiae (3 g) and Fructus Amomi (3 g) for cases with severe abdominal pain. Add Fructus Crataegi (6 g) and Massa Fermentata Medicinalis (6 g) for cases with dyspepsia and discharge of foul stools.

C. Diarrhea of dampness-heat type

Manifestations: Frequent discharge of dark-yellow, foul and watery stool often containing some mucus, hotness and redness of the anus, abdominal pain, poor appetite, fever, restlessness, thirst, oliguria with reddish urine, red tongue with yellow, greasy coating and smooth and rapid pulse.

Therapeutic principles: Clear away heat, and eliminate dampness.

Prescription: The Modification of Decoction of Puerariae, Scutellariae and Coptidis

Radix Puerariae 10 g
Radix Scutellariae 10 g
Rhizoma Coptidis 3 g
Talcum 10 g
Radix Glycyrrhizae 2 g
Pericarpium Citri Reticulatae 5 g
Rhizoma Alismatis 10 g
 

Remarks: Add Radix Paeoniae Alba (10 g) and Radix Aucklandiae (3 g) for cases with severe abdominal pain. Add Pericarpium Arecae (10 g) for those with abdominal distention.

D. Diarrhea due to spleen deficiency

Manifestations: Diarrhea usually occurring after eating, discharge of whitish or yellowish stool containing undigested food, sallow complexion, emaciation, spiritlessness, pale tongue with white coating and deep and weak pulse.

Therapeutic principles: Tonify the spleen, and benefit qi.

Prescription: The Modified Powder of Ginseng, Poria and Atractylodis Macrocephalae

Radix Codonopsis Pilosulae 10 g
Poria 10 g
Rhizoma Atractylodis Macrocephalae 10 g
Radix Glycyrrhizae Praeparata 3 g
Rhizoma Dioscoreae 10 g
Semen Dolichoris Album 10 g
Semen Nelumbinis 10 g
Fructus Amomi 3 g
Radix Platycodi 3 g
Pericarpium Citri Reticulatae 5 g
Semen Coicis (fried) 10 g
 

Remarks: Add Radix Aucklandiae (3 g) for cases with severe abdominal pain.

E. Diarrhea due to deficiency of spleen-yang and kidney-yang

Manifestations: Long-term diarrhea, discharge of thin stool containing undigested food, in some cases prolapse of rectum, coldness of limbs, pale complexion, listlessness, poor appetite, pale tongue with white coating and deep, thready and weak pulse.

Therapeutic principles: Invigorate the spleen, and warm the kidneys.

Prescription: The Modification of Aconiti Lateralis Praeparata Decoction for Regulating Middle-Jiao

Radix Aconiti Lateralis Praeparata 10 g
Rhizoma Zingiberis (dried) 2 g
Radix Codonopsis Pilosulae 10 g
Rhizoma Atractylodis Macrocephalae (fried) 10 g
Radix Glycyrrhizae Praeparata 3 g
Semen Myristicae 10 g
Fructus Psoraleae 10 g
Fructus Chebulae 10 g
 

Remarks: Add Radix Astragali (15 g) and Rhizoma Cimicifugae (3 g) for those with prolapse of rectum.

F. Diarrhea complicated by impairment of yin

Manifestations: Frequent discharge of dark yellow and thin stool, thirst with desire for drinking, oliguria, dryness of skin, irritability, depression of orbits and fontanels, spiritlessness, red lips, crimson and dry tongue and thready and rapid pulse.

Therapeutic principles: Nourish yin with sour-sweet drugs.

Prescription: The Modification of Decoction of Coptidis and Mume

Fructus Mume 10 g
Rhizoma Coptidis 3 g
Flos Chrysanthemi 10 g
Herba Dendrobii 10 g
Radix Ophiopogonis 10 g
Radix Trichosanthis 10 g
Radix Glycyrrhizae 6 g
 

Remarks: Add Radix Panacis Quinquefolii (decocted and taken separately, 10 g) for cases with marked consumption of yin. G. Diarrhea complicated by impairment of yang Manifestations: longstanding diarrhea with discharge of watery stool, mental fatigue, pale complexion, spontaneous sweating, coldness of limbs, pale tongue with white coating and deep pulse.

Therapeutic principles: Recuperate the depleted yang, and rescue the patient from danger.

Prescription: The Modified Decoction of Ginseng and Aconiti Lateralis Praeparata, Os Draconis and Concha Ostreae

Radix Ginseng 10 g
Radix Aconiti Lateralis Praeparata 10 g
Os Draconis 15 g
Concha Ostreae 15 g
Rhizoma Zingiberis (dried) 1 g
Radix Glycyrrhizae Praeparata 6 g
 

Experiential Prescriptions

A. Pericarpium Citri Reticulatae (5 g), Rhizoma Coptidis (3 g), Poria (10 g), Semen Coicis (10 g), Talcum (10 g), Selumbinis (10 g), Fructus Mume (6 g), Fructus Hordei Germinatus (6 g), Semen Dolichoris Album (10 g) and Radix Glycyrrhizae Praeparata (3 g); prepared as decoction; applicable to longstanding cases of diarrhea of dampness-heat type with dampness being more prominent.

B. Radic Condonopsis Pilosulae (10 g), Rhizoma Atractylodis Macrocephalae (fried, 10 g), Poria (10 g), Pericarpium Citri Reticulatae (5 g), Rhizoma Dioscoreae (10 g), Rhizoma Cimicifugae (3 g), Limonitum (10 g) and Radix Glycyrrhizae Praeparata (3 g); prepared as decoction; applicable to cases of diarrhea due to spleen deficiency.

Copyright 1995 Hopkins Technology