Diarrhea - Xie Xie

Chinese Medicine Treatment

Diarrhea is the Increased frequency of bowel movements with a consistency of soft stools, soft stools with undigested food or watery stools.

Patient may also have abdominal pain with borboryigmus.

Diarrhea is usually due to disorder of the spleen's transformation and transportation of fluid function in chronic cases but due to dampness in exterior or interior cases. If there is no dampness then there will be no diarrhea. Diarrhea is most common in summer and fall.

Etiology (causes) of Diarrhea in TCM:

1. Exterior Pathogen Invasion Cold Dampness = attacks L.I.  

- acute - abdominal pain Summer Heat =complicated with damPulse

- attacks Spleen and Stomach 

2. Poor Diet: Impairs spleen function = spleen Qi cannot ascend so transform and transporting function is impaired = Qi and fluids descend.

3. Stress: Depression or Anger = attacks liver, Worry = weaken spleen Qi

4. Long Term Deficiency: Overworked for long period of time with a poor diet, Elderly = general spleen yang deficiency

Differentiate Diarrhea from:

Dysentry diarrhea with PUS and BLOOD and severe abdominal pain with a frequency of more than 7x per day,

Cholera diarrhea accompanied with VOMITTING and severe abdominal pain.

Severe -no appetite Mild - appetite

Chinese Medicine Differentiation and Treatment

Cold Dampness - Acute (cold/damp invades sp and st) Diarrhea: watery, thin Abdominal pain with borborygmus, fullness in abdomen, poor appetite T - white coat exterior invasion) P - floating (exterior invasion) T - white greasy (int. cold damp) P - soft (int. cold damp)

Principle of Treatment: aromatic herbs to transform dampness, expel cold and relieve diarrhea  

Acupuncture  neutral, Moxa, hand and foot yangming, Large Intestine 4, Ren 12, Stomach 25, 37 (LI low he-sea) - more pain  Moxa Ren 8

Herbal Medicine Formula: Ext. wind cold  Huo Xiang Zheng Qi San, Int. cold damPulse - Ping Wei San

Damp Heat - Acute Diarrhea: yellow, stinky Unfinished feeling after passing stool with burning in anus, fever, thirst, dysphoria, scanty-dark urine T - red body, yellow greasy coat P - slippery/soft, rapid

Principle of Treatment: clear heat from Large Intestine, eliminate dampness to stop diarrhea  

Acupuncture points  hand and foot yangming, Large Intestine 4 and Stomach 44 (clear Heat), Ren 12, Stomach 25, 36, 37 - burning anus  bleed Bladder 40 - fever  Large Intestine 11 and Du 14 - HeaTongue - Jin Jin and Yu Yue

Herbal Medicine Formula: Ge Gen Qin Lian Tang

Poor/Irregular Diet - Acute Diarrhea: rotten egg smell food stagnates in stomach and intestines, starts with borbrigimus and abdominal pain, no appetite, pain ameliorated by passing of stool, belching T - thick greasy coating P - slippery

Principle of Treatment: remove food retention to treat diarrhea

Acupuncture points  Shu, Mu, Ren 12, Liver 13, Bladder 20, 21, Stomach 36, Ren 10, Ren 21 and Li Nei Ting (under Stomach 44)

Herbal Medicine Formula: Bao He Wan

Spleen Qi Deficiency - Chronic Diarrhea: undigested food in soft stools Patient always has soft stools, poor appetite, bloating after meals, patient has sensitive stomach to certain foods (ie. Greasy / spicy) dull yellow complexion, fatigue T - pale, white coat P - weak

Principle of Treatment: nourish spleen to invigorate spleen function to stop diarrhea A

cupuncture points - tonify, Moxa, Ren foot taiyin, Shu, Ren 12, Stomach 25, Bladder 21, 25, Ren 9 and Spleen 6 (damp)

Herbal Medicine Formula: Shen Ling Bai Zhu San, Bu Zhong Yi Qi Tang  with prolapse of anus, Tong Xie Yao Fang - with abdominal pain and explosive diarrhea

Kidney Deficiency - Chronic Diarrhea: early morning diarrhea Abdominal pain with borbrygima, ameliorated by passing of stool, general kidney yang deficiency symptoms T - pale, white coat P - deep, thin

Principle of Treatment: warm up spleen and kidney yang to consolidate bowels

Acupuncture points  tonify, Moxa, Bladder 23 and Ren 4, Bladder 20, Liver 13, Stomach 36, Ren 12 and Stomach 25 (regulate intestines), Du 4 and Ren 8 (needle and Moxa)

Herbal Medicine Formula: Si Shen Wan, Zhen Ren Yang Zang Tang

Water Retention in Intestines - Chronic Condition -Diarrhea: watery, frothy diarrhea Dysfunction of in testiness, water retained, always has borborygmi, emaciation, bloated abdomen, scanty urine, thirsty Tongue - pale, swollen, teeth marks P - soft, slippery

Principle of Treatment: invigorate spleen function to eliminate dampness

Herbal Medicine Formula: Ling Gui Zhu Gan Tang

Blood Stasis  Chronic (chronic illness = blood stasis) Fixed stabbing pain in abdomen, unfinished feeling after bowel movement, dry mouth, no desire to drink T - purple spots P - wiry, uneven

Principle of Treatment: promote blood circulation, remove blood stasis to harmonize nutrient level and remove diarrhea

Herbal Medicine Formula: Xue Fu Zhu Yu Tang

Liver Qi Stagnation IBS, emotions induce diarrhea, pain, borborygmi, T- red, thin coat, P- wiry (this usually indicates the liver overacting on the spleen)

Principle of Treatment  soothe Liver, stop diarrhea 

Acupuncture points  foot jueyin, yangming, Bladder 18, Liver 14, 3, Gall bladder 34 (pain), Bladder 20, Ren 12, Stomach 25, 36

Chinese Herbal Medicine - Tong Xie Yao Feng

Alternative Treatment Methods for Diarrhea 

Ear Acupuncture - SI, LI, ST, SP, LR, KI, sympathetic, shenmen, rectum, acute - strong stimulation, chronic  mild stimulation

7 star Needle Acupuncture - T8-lower sacrum area, On lower abdomen on the SP, Stomach and Ren meridians injection  B1 and B12 combo, Stomach 25, 36, 37, Bladder 25

Dysentery

Western Medicine Diagnosis of Dysentry- bacterial or amoebic (protozoan) infections

Traditional Chinese Medicine Diagnosis and Treatment of Dysentry:

Acute Damp/Heat cramping pain, tenesmus (feel the need to defecate although very small amounts are ever discharged- unfinished feeling), pus and fresh blood in stool, scanty yellow urine, fever

Principle of Treatment  clear Heat, transform Damp

Acupuncture points  hand and foot yangming, *LI 4, *ST 25, *37, Large Intestine 11 and Stomach 44 (yangming heat)

Toxic Heat - excess fever, dark purple blood in stool, Ying Xue Heat symptoms (restlessness, eruptions, dry symptoms, may vomit blood, manic behavior), T- deep red with yellow coat, P- slippery rapid

Principle of Treatment  clear Heat, detoxify, stop bleeding

Acupuncture points  Du 14 and Jing-well, *LI 4, *ST 25, *37, Large Intestine 11 and Stomach 44

Damp/Cold Crohns, abdominal pain tenesmus, pus in stool (thick fluids), may contain blood (not very significant), heaviness, fatigue, sticky mouth with no desire to drink, poor appetite, T- white greasy coat, P- soft slow

Principle of Treatment  warm mid Jiao, expel Cold, transform Damp

Acupuncture points  hand yangming, foot taiyin, Moxa, *LI 4, *ST 25, *37, Ren 12, 6, Spleen 9  

Chronic defecient mid Jiao with residual pathogen recurring attacks of dysentery, jelly like stools (pus and blood) Yang deficiency  coldness, T- pale, P- weak

Principle of Treatment  warm mid Jiao

Acupuncture points  Shu, Bladder 20, 21, 22, 23, Ren 4

Yin deficiency  night sweats, dry mouth  

Principle of Treatment  nourish Yin

Acupuncture points  Bladder 20, 21, 22, 23, Kidney 6, Spleen 10

Jin Kou Li cant eat or drink anything without immediately vomiting, mainly caused by Damp/Heat invasion, these people had weak stomachs previous to this invasion

Acupuncture points  *LI 4, *ST 25, *37, Pericardium 6, Ren 12

Alternative Treatment Methods for Dysentry 

injection treatment  -  5% glucose fluid in Stomach 25 (2ml), put needle in until receive the Qi then inject the solution, may also use 0.1% Huang Lian for its antibiotic effects

3 edge cupping treatment - bleed 0.2-0.3 cun around navel then cup overtop of the navel. 

Ear Acupuncture Treatment - Small Intestine LI, ST, SP, LR, KI, sympathetic, shenmen, rectum