One, Key points of differentiation
1, Different etiologies can lead to different patterns and different characteristics of feces. Generally, loose stools with milk clumps or food residue, with an acidic and foul smell, or like rotten eggs, are often caused by injury to the breast or food. Clear and thin stools with a light yellow color and not much smell are often caused by wind-cold. Watery or egg flower soup-like stools, with a large amount, a yellow-brown color, and a foul smell, or with a little mucus, with abdominal pain, are mostly caused by damp-heat. Loose or runny stools, light in color and odorless, occur more after eating, which is due to spleen deficiency. Clear and thin stools without undigested grains, light in color and odorless, mostly belong to deficiency of both the spleen and kidney.
2, The frequency of defecation is generally not more than 10 times, with good spirits, no vomiting, and adequate urine volume, which belongs to mild symptoms. If diarrhea is acute and severe, with frequent and large amounts, and the spirit is萎靡or restless, or there is vomiting, with short and little urine, it belongs to severe symptoms. If there are signs such as dry and withered skin, sunken fontanelle, crying without tears, little or no urine, pale complexion, and debilitated spirit, it indicates a critical and severe change in diarrhea.
3. Differentiating between deficiency and excess in diarrhea with a short course, urgent and violent diarrhea, large volume, abdominal pain, mostly belong to excess. Diarrhea for a long time, slow diarrhea, abdominal distension and preference for pressure, mostly belong to deficiency. Prolonged and difficult to recover, diarrhea is either urgent or slow, abdominal distension and pain is resistant to pressure, mostly belong to deficiency with excess.
Second, treatment principles
Treatment of diarrhea: The basic principle is to transform the spleen and drain dampness. For实证, the main treatment is to expel pathogenic factors, treating different patterns with eliminating food retention and promoting digestion, dispersing wind and cold, and clearing heat and promoting diuresis. For虚证, the main treatment is to reinforce the body's resistance, treating with invigorating the spleen and qi, and warming the spleen and kidney. For diarrhea with varying conditions, treat with invigorating qi and nourishing yin, acid-sweet retaining yin, protecting yin and reversing yang, and rescuing and consolidating. In addition to internal medication, external treatment, massage, acupuncture, and other methods are often used to treat this disease.
1. Diarrhea due to overeating
Syndrome: Loose stools with milk lumps or food residue, acid and foul smell, or like rotten eggs, abdominal distension, pain before defecation, pain reduces after defecation, abdominal pain is resistant to palpation, belching with sour smell, or vomiting, loss of appetite for milk and food, restless sleep at night, thick and greasy tongue coating, or slightly yellow.
Analysis: This syndrome often has a history of irregular milk and food intake. Irregular milk and food intake injures the spleen and stomach, causing malfunctions in transformation, hence the loose stools with undigested milk lumps or food residue. Food retention in the middle-jiao leads to qi stagnation, causing abdominal distension and abdominal pain; after defecation, the accumulation decreases, and the qi mechanism is temporarily unobstructed, hence the temporary relief of abdominal pain after defecation. Internal corruption of milk and food, turbid qi rising, the stomach loses its normal descending function, causing belching with sour smell, or vomiting. Thick and greasy tongue coating or slightly yellow, acid and foul stools, or like rotten eggs, loss of appetite for milk and food, restless sleep at night, are all signs of milk and food retention.
Treatment method: Eliminate food retention and promote digestion.
Prescription: Modified Baohe Pill. Commonly used herbs: Shanzha, Shengfu, Laiwanzi to eliminate food retention and promote digestion, Chenpi, Banxia to regulate qi and reverse, Fuling to invigorate the spleen and drain dampness, Lianqiao to clear heat and resolve stagnation. For abdominal distension and abdominal pain, add Muxiang, Houpu, and Binglang to regulate qi and relieve distension and pain; for vomiting, add Huoxiang and Shengjiang to harmonize the stomach and stop vomiting.
2. Diarrhea due to wind-cold
Syndrome: Loose stools, with a lot of foam in the middle, not very foul smell, intestinal rumbling and abdominal pain, or accompanied by chills and fever, clear nasal discharge, cough, pale tongue, thin white coating.
Analysis: Due to improper nursing, exposure to wind and cold, cold evil attacks the intestines and stomach, causing cold congealing and qi stagnation, the middle-yang is trapped, and the transformation fails, hence the loose stools with a lot of foam and not very foul smell. Wind-cold depression blocks the qi mechanism, causing intestinal rumbling and abdominal pain. Chills, fever, clear nasal discharge, cough, pale tongue, thin white coating are all signs of wind-cold invasion from the exterior.
Treatment method: Disperse wind and cold, transform dampness and harmonize the middle-jiao.
Prescription: Modified Huoxiang Zhengqi Powder. Commonly used herbs: Huoxiang, Suyu, Baizhi, Shengjiang to disperse wind and cold, regulate qi and transform dampness, Dafupi, Houpu, Chenpi, Banxia to warm and dry cold dampness, regulate the qi mechanism, Cangzhu, Fuling, Gancao, Dazao to invigorate the spleen and harmonize the stomach. For loose stools with a light green color and a lot of foam, add Fangfeng to expel wind and stop diarrhea; for severe abdominal pain with internal cold, add Muxiang and Ganjiang to regulate the temperature and relieve pain; for food retention, remove Gancao and Dazao, and add Jiaoshanqu and Shengfu to eliminate food retention; for short and yellow urine, add Zexie and Zhuli to promote diuresis; for external cold, add Jingjie and Fangfeng to enhance the power of resolving exterior and dispelling cold.
3. Diarrhea due to damp-heat
Syndrome: Diarrhea with watery stools or like egg flower soup, urgent and frequent defecation, large volume, foul smell, or with a little mucus, abdominal pain occurs intermittently, loss of appetite, or accompanied by nausea and vomiting, fatigue, or feverish restlessness, thirst, short and yellow urine, red tongue, yellow greasy coating, slippery and rapid pulse.
Analysis: Damp-heat pathogen accumulates in the spleen and stomach, descends to the intestines, fails to transform, hence loose stools resembling water, frequent and copious. Dampness is sticky, heat is urgent, damp-heat intermingles, blocks the Qi of the gastrointestinal tract, hence urgent stools, yellow and smelly, or with a little mucus, intermittent abdominal pain, restlessness and unease; dampness obstructs the spleen and stomach, hence poor appetite, or even nausea, fatigue. If accompanied by external syndrome, fever occurs; heat heavier than dampness leads to thirst; damp-heat descending leads to short and yellow urine; red tongue, yellow greasy coating, and slippery and rapid pulse are all signs of damp-heat.
Treatment method: Clearing heat and promoting diuresis.
Herbal medicine: Ge Gen Huangqin Huanglian Decoction with modifications. Commonly used herbs: Ge Gen for expelling exterior and heat, producing body fluid and ascending Yang, Huangqin and Huanglian for clearing damp-heat in the gastrointestinal tract, Gancao for harmonizing the herbs, collectively achieving the effect of expelling exterior and clearing the intestines, and resolving both exterior and interior. For heat heavier than dampness, add Lianqiao, Machidang, and Machaicao for clearing heat and detoxifying; for dampness heavier than heat, add Huashi, Cheqianzi, Fuling, and Cangzhu for drying dampness and promoting diuresis; for abdominal pain, add Muxiang for regulating Qi and relieving pain; for thirst, add Shengshi and Lugen for clearing heat and producing body fluid; for damp turbidity obstructing in summer, add Huoxiang and Peilan for aromaticizing damp turbidity; for vomiting, add Zhuru and Banxia for reversing and stopping vomiting.
4. Diarrhea due to spleen deficiency
Symptoms: Loose stools, pale color and no odor, diarrhea after eating, varying in severity, sallow complexion, emaciated body, fatigue, pale tongue with white coating, slow and weak pulse.
Analysis: Deficiency of the spleen and stomach leads to the failure of the rising of clear Yang, and the failure of transformation, hence loose stools, pale color and no odor, varying in severity. Deficiency of the spleen and stomach leads to the loss of the function of transportation and reception, hence diarrhea after eating. Chronic diarrhea leads to deficiency of the spleen, failure of transportation of essence and Qi, lack of source of vital Qi and blood, hence sallow complexion, emaciated body, fatigue, pale tongue with white coating, and slow and weak pulse.
Treatment method: Invigorate the spleen and Qi, assist digestion and stop diarrhea.
Herbal medicine: Shenling Baizhu Powder with modifications. Commonly used herbs: Dangshen, Baizhu, Fuling, and Gancao for invigorating Qi and tonifying the spleen, Shanyao, Lianrou, Biandou, and Yiren for invigorating the spleen and transforming dampness, Sharen and Jiegeng for harmonizing Qi and regulating the stomach. For poor appetite, greasy tongue coating, add Huoxiang, Chenpi, and Jiaoshan for aromaticizing dampness, regulating Qi, and assisting digestion; for abdominal distension, add Muxiang and Zhike for regulating Qi and reducing abdominal distension; for cold abdomen and pale tongue, with undigested matter in the stool, add Ganjiang to warm the middle-jiao and dispel cold, warm the spleen and assist digestion; for prolonged diarrhea without retention, add Roudouko, Hezi, and Shiliupi to astringe and stop diarrhea.
5. Diarrhea due to Yang deficiency of the spleen and kidney
Symptoms: Prolonged diarrhea without cessation, loose stools, undigested grains, prolapse of the rectum, feeling cold in the limbs, pale complexion, debility, eyes open during sleep, pale tongue with white coating, thready and weak pulse.
Analysis: Prolonged diarrhea without cessation, deficiency of Yang in the spleen and kidney, decline of the gate of life fire, unable to warm the spleen earth, hence loose stools and undigested grains. Deficiency of the spleen leads to Qi sinking, resulting in prolapse of the rectum. Deficiency of kidney Yang leads to endogenous Yin cold, hence feeling cold in the limbs, pale complexion, debility, eyes open during sleep, pale tongue with white coating, and thready and weak pulse.
Treatment method: Tonify the spleen and kidney, astringe and stop diarrhea.
Herbal medicine: Fuzi Lizi Decoction combined with Sishen Wan with modifications. Commonly used herbs: Dangshen, Baizhu, and Gancao for invigorating the spleen and Qi, Ganjiang and Wuzhuyu for warming the middle-jiao and dispelling cold, Fuzi, Buguzhi, Roudouko, and Wuweizi for warming the kidneys and spleen, astringing and stopping diarrhea. For prolapse of the rectum, add Zhishihuang and Shengma to elevate the middle Qi; for prolonged diarrhea without cessation, add Hezi, Shiliupi, and Chishizhi to astringe and stop diarrhea.
Second, Variant Symptoms
1, Qi and Yin injury
Symptoms: Excessive diarrhea, thin and watery in quality, lack of vitality or restlessness and anxiety, sunken orbits and anterior fontanelle, dry or withered skin, crying without tears, thirst and drinking, less or no urine, red tongue and little moisture, thin or no coating, fine and rapid pulse.
Analysis: This condition often originates from damp-heat diarrhea, due to excessive diarrhea, loss of body fluid, Yin and Yang are attacked, Qi is deficient and fluid is deficient, the skin is not nourished, so the orbits and anterior fontanelle are sunken, the skin is dry or withered, crying without tears, lips are red and dry, and lack of vitality. Due to insufficient body fluid, there is less or no urine. The stomach Yin is injured, and there is no fluid to ascend, so there is dry mouth and thirst. Insufficient Qi and Yin, the heart is not nourished, so there is restlessness and anxiety. The tongue is red and lacks moisture, the coating is thin or absent, the pulse is fine and rapid, all indicating injury of Qi and Yin.
Treatment Method: Tonify Qi and nourish Yin, acid and sweet to consolidate Yin.
Herbal Formula: Ginseng and Wu梅Decoction with modifications. Commonly used herbs: Ginseng and Zhigancao tonify Qi and support the Spleen, Wumei astringes the intestines and stops diarrhea, Muhua removes dampness and harmonizes the Stomach, the four herbs combined can transform sour and sweet into Yin, Lianzi and Shanyao strengthen the Spleen and stop diarrhea. For chronic diarrhea without cessation, add Shaoyao, Hezi, and Chishizhi to astringe the intestines and stop diarrhea; for thirst and drinking, add Shihuan, Yuzhu, Tianhuafen, and Lugen to nourish Yin and generate body fluid to relieve thirst; for hot and smelly stool, add Huanglian to clear internal damp-heat.
2, Yin exhaustion and Yang loss
Symptoms: Continuous diarrhea, frequent and large amount, lack of vitality, blank expression, gray or pale complexion, weak crying, crying without tears, less or no urine, cold extremities, pale tongue without moisture, deep and fine pulse.
Analysis: This condition is often seen in acute diarrhea or chronic diarrhea without cessation, which consumes body fluid, damages Yin and affects Yang, and Qi follows the fluid. Yin is injured internally, so there is crying without tears, less or no urine; Yang is lost externally, and then there is a lack of vitality, a blank expression, weak crying, gray or pale complexion, and cold extremities. The tongue is pale and lacks moisture, the pulse is deep and fine and about to break, indicating the exhaustion of Yin and Yang.
Treatment Method: Rescue Yin and Yang, consolidate and relieve the counterflow.
Herbal Formula: Shengmai Powder combined with Shenfu Longmu Rescue Decoction with modifications. Commonly used herbs: Ginseng tonifies Qi and strengthens the Spleen, Maimendong, Wuweizi, Baishao, and Zhigancao nourish Qi and Yin, transform sour and sweet into Yin, Fuzi warms the Yang and consolidates the loose, Longgu and Muli subdue the Yang and rescue.
