Chronic diarrhea

　　1. Systemic diseases
　　(1) Diabetic diarrhea is related to gastrointestinal autonomic neuropathy.
　　(2) Hyperthyroidism can lead to frequent bowel movements or diarrhea due to fast intestinal peristalsis and poor digestion and absorption. The stool is usually paste-like and contains a lot of undigested food.
　　(3) Chronic renal insufficiency.
　　(4) Autoimmune diseases such as systemic lupus erythematosus, scleroderma, Behcet's syndrome, and others.

　　2. Diseases of the liver, gallbladder, and pancreas
　　(1) Hepatitis, liver cirrhosis, liver cancer.
　　(2) Chronic pancreatitis, pancreatic cancer.
　　(3) Cholecystectomy after surgery.

　　3. Gastrointestinal diseases
　　(1) Gastrointestinal tumors.
　　(2) Inflammatory bowel disease.
　　(3) Functional intestinal irritable syndrome, functional diarrhea.
　　(4) Infectious intestinal tuberculosis, amebic enteritis, chronic dysentery, fungal infection.
　　(5) Drug-induced diarrhea: The interaction of various drugs or drug-drug interactions can trigger chronic diarrhea.

　　1. Malnutrition and vitamin deficiencies:Chronic diarrhea may last for a long time. If fasting is prolonged or long-term insufficient calorie intake, it can often cause malnutrition and various vitamin deficiencies. Dyspepsia and malnutrition can cause each other, often causing a vicious cycle that leads to adverse consequences. Vitamin A deficiency can cause xerophthalmia and corneal softening; vitamin D deficiency can cause tetany.

　　2. Infection:Common infections include otitis media, angular cheilitis, upper respiratory tract infection, bronchitis, pneumonia, boils, sepsis, urinary tract infection, and phlebitis. Various infections may become causes of diarrhea, but there may also be secondary infections due to decreased overall resistance after diarrhea. Chronic diarrhea or children with pre-existing malnutrition are prone to fungal infections, such as thrush, fungal enteritis, and even systemic fungal disease.

　　3. Toxic hepatitis:Severe diarrhea may cause jaundice, which is common in children with malnutrition and severe sepsis, with poor prognosis. Therefore, toxic hepatitis is one of the serious complications of diarrhea.

　　4. Other:It may cause acute renal failure, disseminated intravascular coagulation, infectious shock, toxic encephalopathy, and other conditions. Improper treatment may also lead to acute heart failure, hyperkalemia, toxic colonic paralysis, intestinal bleeding, intussusception, and occasionally intestinal perforation and peritonitis.

　　I. Abnormal defecation
　　1. Manifested as increased frequency of defecation, loose stools, and even with mucus, pus, and blood. Generally, it lasts for more than two months.
　　2. The characteristic of diarrhea caused by small intestinal lesions is abdominal discomfort, often located around the umbilicus, which intensifies after meals or before defecation. This type of diarrhea does not cause tenesmus, with frequent, loose stools, light in color, and variable frequency.
　　3. The characteristic of diarrhea caused by colonic lesions is abdominal discomfort, usually located on both sides or the lower abdomen, which often relieves or subsides after defecation. Colonic lesions often cause frequent and urgent bowel movements, with small amounts of stool that may contain blood and mucus; rectal lesions often cause tenesmus.

　　II. Accompanying symptoms of diarrhea
　　Diarrhea may be accompanied by abdominal pain, fever, weight loss, abdominal mass, or peptic ulcer, etc., depending on the cause.

　　The best way to prevent chronic diarrhea is to develop good living habits, pay attention to the hygiene and rationality of diet.

　　1. Fasting during the acute phase:During the diarrhea phase, temporary fasting is required to allow the intestines to rest completely. If necessary, intravenous fluid administration is recommended to prevent excessive fluid loss and dehydration.

　　2. Light, liquid diet:Patients who do not need to fast should be given light, liquid foods during the early stages of the disease. These include protein water, fruit juice, rice gruel, thin noodle soup, etc., with salt as the main flavor. Early-stage fasting should avoid milk and sucrose, which are easily gas-producing liquid foods. Some patients may not tolerate milk well, and consuming milk can often worsen diarrhea.

　　3. Adjust diet according to the condition:After the frequency of defecation decreases and the symptoms are relieved, change to low-fat liquid diet or low-fat, low-fiber, soft and easy-to-digest semi-liquid diet, such as rice congee, lotus root powder, soft noodles, noodles, etc.

　　4. Diet selection:After the diarrhea basically stops, low-fat, low-fiber semi-liquid diet or soft food can be provided. Eat small and frequent meals to facilitate digestion, such as noodles, congee, steamed buns, soft rice, minced lean meat, etc. It is still necessary to appropriately limit vegetables and fruits with high rough fiber, and gradually transition to normal food in the future.

　　5. Vitamin supplement:Pay attention to the supplement of vitamin B complex and vitamin C, such as fresh orange juice, fruit juice, tomato juice, vegetable soup, etc.

　　6. Dietary taboos: Prohibit alcohol, avoid fatty meat, hard and rough-fiber-containing vegetables, raw and cold fruits and vegetables, pastries, and cold drinks, etc.

　　7. Daily life:Pay attention to keeping warm, be careful in daily life, protect the waist and abdomen, and avoid cold.

　　8. Hygiene habits:Develop good hygiene habits, do not eat unclean food.

　　Chronic diarrhea needs the following examinations to be diagnosed:

　　1. Stool examination:Including hematochezia, pus cells, protozoa, eggs, fat droplets, etc. It is one of the routine laboratory examination items. Through this examination, it can be more intuitively understand some pathological phenomena of the gastrointestinal tract, and indirectly judge the functional status of the digestive tract, pancreas, and liver and gallbladder. It is divided into gross general physical examination, microscopic examination, and chemical examination.

　　2. Small intestinal absorption function test:Show malabsorption of the intestines.

　　3. X-ray and endoscopy:Detect the location of the lesion, the state of motion function, gallstones, etc. X-ray examination has a wide application in the diagnosis of anorectal surgical diseases and is one of the most effective means for early discovery, early diagnosis, and differential diagnosis of certain diseases in clinical practice. With the accumulation of X-ray examination and diagnosis experience, continuous improvement of equipment, and the application of new technologies, X-ray examination has become an indispensable tool in the diagnosis of anorectal surgical diseases.

　　4. Ultrasound:Ultrasound examination is to observe by using the reflection of ultrasonic waves in the human body.

　　5. Small intestinal mucosal biopsy:Generally, if there is an abnormality, it can be diagnosed after examination.

　　Diet suitable for chronic diarrhea patients:

　　1. Low-fat, low-fiber diet: About 40g of fat per day, excessive fat is difficult to digest and can increase the burden on the gastrointestinal tract, stimulate gastrointestinal motility and worsen diarrhea. Therefore, vegetable oil should also be limited, and attention should be paid to cooking methods, mainly steaming, boiling, blanching, braising, and roasting, and oil-frying, stir-frying, and slippery cooking should be prohibited. Foods that can be consumed include lean meat, chicken, shrimp, fish, and soy products. Foods with high rough fiber can stimulate intestinal motility and worsen diarrhea. When diarrhea occurs frequently, it is best to temporarily not eat or eat as little as possible vegetables and fruits, and fresh fruit juice, tomato juice can be given to supplement vitamins. Low-fiber diet can reduce intestinal motility and alleviate diarrhea, so it is advisable to eat thin noodles, congee, soft rice, etc.

　　2. Provide high-calorie, high-protein diet. Consume easily digestible protein foods such as eggs, lean meat, fish, chicken, tofu. The cutting should be fine, do not use large pieces of meat. The food texture should mainly be minced meat, diced meat, shredded meat, minced meat, steamed egg custard, boiled eggs, and can also have appropriate snacks.

　　3. High-quality protein foods such as fish, lean meat, eggs, and various bean products are less greasy and nutritious, which can be appropriately selected. To increase vitamin C without exacerbating diarrhea, choose fruits with less fiber, such as bananas, pineapples, apple puree, or cooked apples.

　　4. When chronic diarrhea has dehydration symptoms, it is necessary to replenish light salted water in time to make up for the loss of water and salt, such as milk, lotus root starch, vegetable juice, fruit juice, egg soup, soft noodles, and congee.

　　5. Choose some健脾止泻 foods such as Coix Seed, Yam, Jujube, Lotus Seed (without core), Chestnut, Euryale Flos, Mung bean, tea, garlic, vinegar, etc.

　　Foods to avoid for chronic diarrhea patients:

　　1. Avoid allergic foods.

　　2. Foods to avoid: such as coarse grains, raw and cold fruits and vegetables, cold mixed vegetables, leeks, celery, and sauerkraut containing a lot of rough fiber.

　　3. Difficult-to-digest meats such as ham, sausages, and cured meats.

　　4. Stimulative foods such as chili, strong alcohol, mustard, chili powder, as well as high-fat foods such as fatty meat, fried pastries, etc.

　　1. Kidney Deficiency Diarrhea
　　Syndrome: Abdominal pain before dawn, diarrhea immediately after intestines rumble, undigested grains, feeling comfortable after defecation, aversion to cold, cold limbs, soreness in the lower back and knees, pale tongue, white fur, deep and fine pulse.
　　Treatment Method: Warming and tonifying the spleen and kidney, astringing and stopping diarrhea.
　　Master Formula: Modified Lijun Decoction combined with Si Shen Wan.
　　Addition and Subtraction: If the elderly are physically weak and have chronic diarrhea that does not stop, the middle qi sinks, add Astragalus, Fructus Terminaliae Chebulae, and Rubia cordifolia to invigorate the body and raise the yang, as well as astringent and stop diarrhea, Peach Flower to astringe and stop diarrhea.

　　2. Retention of Fluid and Dampness in the Intestine
　　Syndrome: Emaciated body, intestines rumbling with sound, liquid stool, or stool in foam-like shape, vomiting clear water, abdominal distension and oliguria, soft and slippery pulse, pale tongue quality, white slippery fur.
　　Treatment Method: Strengthen the spleen and promote diuresis, eliminate dampness in both the front and back.
　　Master Formula: Modified Linggui Zhugan Decoction combined with Jishu Pill.
　　Addition and Subtraction: If there is abdominal pain, add Guizhi Decoction together with the same use, to harmonize the collateral and relieve pain.

　　3. Obstruction of Intestine Collateral
　　Syndrome: Long-term diarrhea, a sense of incomplete defecation after diarrhea, piercing pain in the abdomen, pain in a fixed place, severe pain when pressed, ashy complexion, ecchymosis on the edge of the tongue or dark red tongue quality, dry mouth without a desire for much drinking, wiry and small pulse.
　　Treatment Method: Promote blood circulation and remove obstruction, harmonize the collateral and relieve pain.
　　Master Formula: Modified Shaofu Decoction.
　　Addition and Subtraction: If there is blood stasis, it turns into pus and blood, and the stool contains red and white sticky sputum, add Flos Farfarae together with the same use, to clear heat and cool the blood.