Diarrhea refers to an abnormal frequency and liquidity of fecal discharges but without tenesmus or purulent and blood stools.

Etiology and Pathogenesis

The disease chiefly involves the spleen, stomach and intestines and also affects the liver and kidneys. The common causes of diarrhea are the effects of dampness, immoderate diet and drinking, hypofunction of the spleen and stomach, emotional upsets and deficiency of kidney-yang. The hypofunction of spleen with failure of transportation and transformation and the domination of dampness serve as the chief pathogenesis.

Syndrome Differentiation and Therapeutic Principles

A. Syndrome differentiation

(a) Differentiation between diarrhea and dysentery: Diarrhea is characterized by watery discharges and abdominal pain relievable after bowel movement, while dysentery is marked by discharge of bloody and mucous stools and accompanied by tenesmus.

(b) Identification of acute and chronic cases: Acute diarrhea is attributable to cold-dampness, dampness-heat and improper diet, while chronic diarrhea may result from deficiency of the spleen and stomach, deficiency of spleen-yang and kidney-yang and in coordination of the liver and spleen.

(c) Differentiation between cold and heat as well as asthenia and sthenia syndrome: Diarrhea with thin and watery stools containing undigested food is attributed to cold-syndrome, and that with yellow-brown and odorous stool, urgency of bowel movement and hot feeling of the anus is considered due to heat-syndrome. A chronic case with abdominal pain relievable by warmth, fatigue and cold limbs is attributed to asthenia-syndrome, and that with severe abdominal pain and tenderness is considered due to sthenia-syndrome.

B. Therapeutic Principles

There are nine therapeutic principles for diarrhea summarized by the ancient physicians, namely, eliminating dampness with bland drugs, clearing away heat, lifting up middle-jiao qi, dredging with diuretics, soothing with sweet drugs, alleviating diarrhea with sour drugs, drying the spleen, warming the kidneys and arresting discharge with astringents. These principles should be applied accordingly.

Classification and Treatment

A. Diarrhea of cold-dampness type

Manifestations: Watery stool, abdominal pain, increased borborygmus, loss of appetite, pale tongue with white greasy coating and deep and slow pulse.

Therapeutic principles: Expel cold and dampness, and arrest diarrhea.

Prescription: The Modification of Weiling Decoction

Rhizoma Atractylodis Praeparata 10 g
Pericarpium Citri Reticulatae 10 g
Polyporus Umbellatus 10 g
Ramulus Cinnamomi 5 g
Cortex Magnoliae Officinalis 6 g
Poria 15 g
Rhizoma Atractylodis Macrocephalae 10 g
Radix Glycyrrhizae Praeparata 3 g

Remarks: Add Radix Ledebouriellae and Herba Schizonepetae for cases with fever, chilliness and general aching. Add Massa Fermentata Medicinalis and Fructus Hordei Germinatus for those with dyspepsia. Add Rhizoma Zingiberis Recens, Rhizoma Pinelliae and herba Agastachis for those with nausea and vomiting.

B. Diarrhea of dampness-heat type

Manifestations: Discharge of odorous, loose stool, abdominal pain, burning sensation in the anus, restlessness, thirst, dark yellow urine, thick and yellow greasy tongue coating and soft-floating and rapid pulse.

Therapeutic principles: Clear away heat and eliminate dampness.

Prescription: The Modified Decoction of Puerariae, Scutellariae and Coptidis

Radix Puerariae 15 g
Rhizoma Coptidis 5 g
Semen Plantaginis 10 g
Rhizoma Alismatis 10 g
Radix Scutellariae 10 g
Flos Lonicerae 10 g
Talcum 15 g

Remarks: Add Radix Paeoniae Alba and Radix Aucklandiae for cases with severe abdominal pain. Add Cortex Phellodendri and Radix Sophorae Flavescentis for those with burning sensation in the anus. Add Rhizoma Pinelliae, Herba Agastachis, Pericarpium Citri Reticulatae and Caulis Bambusae in Taeniam for treating cases with nausea and vomiting.

C. Diarrhea due to indigestion

Manifestations: Diarrhea with discharge of odorous stool, abdominal pain relieved after bowel movement, distension over the epigastrium and abdomen, eructation, anorexia, thick greasy tongue coating and wiry and smooth pulse.

Therapeutic principles: Relieve dyspepsia, and stop diarrhea.

Prescription: The Modified Decoction of Invigorating the Middle Jiao

Rhizoma Pinelliae 10 g
Cortex Magnoliae Officinalis 6 g
Fructus Aurantii 10 g
Radix Aucklandiae 6 g
Rhizoma Alismatis 10 g
Pericarpium Citri Reticulatae 10 g
Fructus Crataegi (fried) 10 g
Fructus Hordei Germinatus 10 g
Fructus Amomi 5 g

Remarks: Add Poria and Semen Plantaginis for cases with watery diarrhea. Add Radix et Rhizoma Rhei, Radix Angelicae Sinensis and Radix Paeoniae Alba for those with severe abdominal pain and diarrhea with a sensation for incomplete evacuation.

D. Diarrhea due to weakness of the spleen and stomach

Manifestations: Loose stool containing undigested food, fullness over the epigastrium and abdomen, poor appetitie, sallow complexion, fatigue, pale tongue with thin, greasy coating and deep and slow pulse.

Therapeutic principles: Strengthen the spleen and stomach, and eliminate dampness.

Prescription: The Modified Powder of Codonopsis Pilosulae, Poria and Atractylodis Macrocephalae

Radix Codonopsis Pilosulae 15 g
Poria 15 g
Semen Coicis 20 g
Semen Nelumbinis 10 g
Radix Auckloandiae 5 g
Rhizoma Atractylodis Macrocephalae 10 g
Semen Dolichoris Album 15 g
Rhizoma Dioscoreae 15 g
Pericarpium Citri Reticulatae 10 g
Radix Glycyrrhiae Praeparata 5 g

Remarks: Add Endothelium Corneum Gigeriae Galli, fructus Crataegi (fried), Fructus Hordei Germinatus (fried) and fructus oryzae Germinatus (fried) for cases with anorexia. Add Fructus Chebulae and Semen Myristicae for those with frequent bowel movements. Add Rhizoma Zingiberis Praeparata, Fructus Evodiae and Cortex Cinnamomi for cases with uncontrollable discharge of loose stool and cold pain in the abdomen due to deficiency of middle-jiao yang. Add Bolus for Strengthening Middle Jiao and Benefiting Qi for longstanding cases of diarrhea with prolapse of rectum.

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

Manifestations: Morning diarrhea, abdominal pain and increased borborygmus before bowel movement, weakness and soreness of lumbus and knees, coldness of lower extremities, pale tongue with white coating and deep and thready pulse.

Therapeutic principles: Warm the kidneys and benefit the spleen, and arrest diarrhea by using astringents.

Prescriptions: Pill of Four Miraculous Drugs with Aconiti Lateralis Praeparata Decoction for Regulating Middle Jiao

Fructus Psoraleae 15 g
Fructus Schisandrae 6 g
Radix Aconiti Lateralis Praeparata 10 g
Fructus Evodiae 10 g
Semen Myristicae 10 g
Radix Codonopsis Pilosulae 12 g
Rhizoma Atractylodis Macrocephalae 12 g
Rhizoma Zingiberis Praeparata 6 g
Radix Glycyrrhizae 5 g

F. Diarrhea due to incoordination of the liver and spleen

Manifestations: Diarrhea upon onset of abdominal pain (which is not alleviated after bowel movement and is aggravated by anger), oppression and distention over the chest and hypochondrium, eructation, poor appetite, reddish tongue with white, greasy coating and thready and wiry pulse.

Therapeutic principles: Clear away liver-fire, support the spleen, and stop diarrhea.

Prescription: Decoction for Relieving Pain and Diarrhea

Radix Paeoniae Alba 30 g
Rhizoma Atractylodis Macrocephalae 15 g
Rhizoma Dioscoreae 12 g
Radix Bupleuri 10 g
Radix Ledebouriellae 10 g
Pericarpium Citri Reticulatae 10 g
Semen Dolichoris Album 15 g
Semen Plantaginis (fried) 10 g

Remarks: Add Radix Puerariae and Fructus Chebulae for cases with frequent bowel movements. Add fructus mume, Radix Glycyrrhizae and Rhizoma Corydalis for those with severe abdominal pain.

Experiential Prescriptions

A. Semen Plantaginis 915 g), Rhizoma Zingiberis Recens 910 g) and Ignited Yellow Earth (60 g); prepared as decoction; applicable to diarrhea of cold-dampness type.

B. Radix Puerariae 912 g), Radix Scutellariae 910 g) and Stylus Maydis (30 g); prepared as decoction; indicated for diarrhea of dampness-heat type.

C. Fructus Crataegi (fried, 60 g) and Semen Dolichoris Album (30 g); prepared as decoction; applicable to acute diarrhea.

D. One piece of Pericarpium Granati and 30 g of Brown Sugar; prepared as decoction; applicable to chronic diarrhea.

E. Galla Chinensis (moderate dose) dried and powdered; prepared as small pills; 3 pills to be taken three times daily; applicable to chronic diarrhea.

F. Cortex Ailanthi (45 g) and Brown Sugar (45 g); prepared as decoction; applicable to chronic diarrhea.

G. Rhizoma Atractylodis Macrocephalae (15 g) and Semen Plantaginis (15 g); prepared as decoction; indicated for diarrhea due to spleen deficiency.

H. Fructus Chebulae 930 g) and Cortex Cinnamomi (30 g); powdered and prepared as pills; 3 to 5 grams taken twice daily; indicated for diarrhea due to kidney deficiency.

Copyright 1995 Hopkins Technology