Diarrhea

//Western Diagnosis// increased volume, fluidity, or frequency of bowel movements more than 300gm/d (average in US is 100-300gm/d) a symptom, not a disease

Etiology
non-absorbable, water-soluble solutes in bowel -lactose, simple CHO
 * osmotic**

secrete electrolytes and water - bacterial toxins, viruses
 * secretory**

mucosal inflammation and ulceration
 * exudative**

not enough exposure to absorptive surface for a sufficient amount of time [18-30hrs. is pretty average]
 * decreased intestinal transit time**

Parasitic infections
1. Entameba histolytica 2. Giardia lamblia 3. Enterobius vermicularis [pinworm] 4. dx by Ovum & Parasite exam

Treatment
1. find and tx underlying disorder 2. rehydration [water alone is not best - electrolytes, etc.] 3. avoid simple CHO 4. charcoal 5. rice water 6. psyllium seed [metamucil] 7. acidophilus 8. hydrastis [Goldenseal]

10-12 bowel movements a day may be an infection of candida

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Diarrhea (Xìe xìe)
Characterized by changes in the frequency and quality of bowel movements Frequent passage of unformed, loose/soft or watery stool that may or may not contain undigested food Can occur in all seasons, but more common in summer and fall

Relevant Biomedical Diseases
-“Stomach flu” -Acute gastritis -Acute or chronic enteritis -Acute or chronic colitis -Malabsorption syndrome -IBS -Food poisoning -IBD -Intestinal tumor

TCM Etiology and Pathology
-Attack of Spleen by exogenous Dampness -> Damp accumulation

-Improper diet (poor food choices or excessive or irregular food intake) -> Food Stagnation

-Intensive or persistent emotional stress -> Liver attacking the Spleen (Liver/Spleen disharmony)

-Overexertion or pensiveness -> Spleen Qi vacuity with failure of the Spleen in transforming and transporting

-Weak constitution, prolonged disease, aging -> Kidney and Spleen Yang vacuity

Distinguishing Vacuity Patterns from Repletion Patterns

 * ===**Vacuity Patterns**=== || ===**Repletion Patterns**=== ||
 * -Acute onset, short course

-Increased frequency of bowel movements

-Abdominal pain aggravated by pressure and relieved by defecation || -Chronic and prolonged

-Intermittent episodes of diarrhea

-Abdominal pain relief by pressure and aggravated by defecation ||

Distinguishing Cold Patterns from Heat Patterns

 * === === || ===**Cold Pattern**=== || ===**Heat Pattern**=== ||
 * **Quality of Stool** || Loose or watery stool, possibly containing undigested food || Sticky yellow stool with foul smell and urgency and burning sensation of the anus ||
 * **Abdominal Pain** || Severe pain with loud borborygmus that is relieved by warmth || Burning pain with alternation of pain and diarrhea ||
 * **Thirst** || No thirst or desire for warm beverages || Intense thirst with preference for cold beverages ||
 * **Urination** || Clear, profuse urine || Dark, scanty urine ||
 * **Tongue** || Moist white coating || Red with yellow coating ||
 * **Pulse** || Deep and tight || Slippery and rapid ||

Other Diagnostic Tips for Diarrhea

 * ===**Symptom**=== || ===**Diagnostic Significance**=== ||
 * Acute diarrhea with a short course || Exuberance of Dampness ||
 * Chronic diarrhea with a long course and often induced by eating or overexertion || Spleen vacuity ||
 * Early AM diarrhea with coldness in the loins || Decline of Ming Men Fire/Yang vacuity ||
 * Diarrhea with normal appetite || Mild condition with good prognosis ||
 * Severe diarrhea with weight loss || Severe condition with poor prognosis ||

Identification of Pathology by Stool Characteristics
-Yellow sticky or pasty stool with a strong foul odor and burning sensation of the anus = Damp-Heat -Bluish-gray or bluish-black school with a clear and thin or watery consistency without significant odor = Cold-Dampness -Pasty stool containing undigested food with a foul odor like rotten eggs and a sensation of incomplete defecation = Food Stagnation -Paroxysmal loose stool or diarrhea triggered or aggravated by emotional stress = Liver/Spleen Disharmony -Loose stool or diarrhea aggravated by overexertion or rich foods = Spleen vacuity -Watery stool or diarrhea containing undigested food with abdominal pain that occurs in the early AM hours = Yang vacuity

Differential Diagnosis of Diarrhea and Dysentery

 * === === || ===Diarrhea=== || ===Dysentery=== ||
 * **Location** || Spleen/Stomach || Intestines ||
 * **Pathogenesis** || Spleen vacuity with Damp accumulation || Damp or Toxic Heat restricts Qi and Blood flow and decomposes tissue leading to diarrhea with pus and blood, abd. pain, tenesmus ||
 * **Symptoms** || Abdominal pain, borborygmus, no presence of pus or blood || Purulent, bloody stool, severe abdominal pain, tenesmus ||
 * **Treatment** || Strengthen the function of the Spleen and Stomach || Rectify Qi and Blood, remove stagnation from Intestines ||

Attack by External Cold-Damp
Huo Xiang (12g.), Zi Su Ye (6g.), Bai Zhi (6g.), Chen Pi (9g.), Da Fu Pi (9g.), Hou Po (9g.), Bai Zhu (12g.), Fu Ling (9g.), Jie Geng (9g.), Sheng Jiang (6g.), Da Zao (2 pcs.), Zhi Gan Cao (3g.)]
 * Signs:** diarrhea with loose or watery stool, borborygmus, abdominal pain
 * Symptoms:** preference for warmth, fullness and distention in the epigastrum, poor appetite, no thirst, possible simultaneous chills and fever, headache, nasal congestion, general aching
 * Tongue:** white, greasy coating
 * Pulse:** soggy and moderate
 * Treatment Principle:** Scatter Cold to release the exterior, resolve Dampness with aromatic medicinals, and stop diarrhea
 * Herbal Treatment:** Huo Xiang Zheng Qi San (Agastache/Patchouli Qi Righting Powder)

Damp-Heat in the Middle Jiao
Ge Gen (10g.), Huang Qin (10g.), Huang Lian (10g.), Zhi Gan Cao (5g.)]
 * Signs:** Urgent, foul-smelling, yellow/pasty and explosive diarrhea with abdominal pain or sensation of incomplete defecation
 * Symptoms:** burning sensation in the anus during bowel movement, traditionally seen in the summer and fall, persistent fever, thirst with a desire for little drink, scanty yellow urine
 * Tongue:** yellow, greasy coating
 * Pulse:** slippery, rapid or soggy, rapid
 * Treatment Principle:** Clear Heat and eliminate Dampness, stop diarrhea
 * Herbal Treatment:** Ge Gen Qin Lian Tang (Pueraria, Scutellaria, and Coptis Decoction)

Food Stagnation in the Stomach and Intestines
Ban Xia (10g.), Chen Pi (10g.), Zhi Gan Cao (10g.), Shan Zha (10g.), Shen Qu (10g.), Lai Fu Zi (10g.), Lian Qiao (10g.)]
 * Signs:** diarrhea or loose stool the smell of rotten eggs that may contain undigested food, distending abdominal pain relieved after diarrhea
 * Symptoms:** borborygmus, fullness in the epigastrium and abdomen, belching with foul-smelling, acid regurgitation, foul breath, no appetite / anorexia
 * Tongue:** thick, greasy coating
 * Pulse:** slippery
 * Herbal Treatment:** Bao He Wan (Harmony Preserving Pill)

Liver/Spleen Disharmony
Bai Zhu (15g.), Bai Shao Yao (12g.), Chen Pi (6g.), Fang Feng (6g.)]
 * Signs:** recurrent, painful diarrhea and borborygmus induced by anger or emotional strain, abdominal pain is somewhat relieved after diarrhea,
 * Symptoms:** stuffiness or distention in the chest and hypochondrium, depression, anger/irritability, moodiness, belching, poor appetite, gas
 * Tongue:** thin, white coat
 * Pulse:** wiry
 * Treatment Principle:** Soothe the Liver, regulate Qi, strengthen the Spleen, stop diarrhea
 * Herbal Treatment:** Tong Xie Yao Fang (Pain and Diarrhea Formula)

Spleen Qi Vacuity
Dang Shen (15g.), Bai Zhu (12g.), Fu Ling (12g.), Shan Yao (12g.), Bai Bian Dou (9g.), Yi Yi Ren (6g.), Lian Zi (6g.), Sha Ren (6g.), Jie Geng (6g.), Zhi Gan Cao (12g.)]
 * Signs:** loose or watery stools that may contain undigested food, increased frequency of bowel movement after exertion or after eating rich and greasy foods
 * Symptoms:** epigastric and abdominal fullness and distention (particularly after eating), poor appetite, sallow complexion, lassitude, fatigue
 * Tongue:** pale with white coating
 * Pulse:** thin, weak
 * Treatment Principle:** Strengthen the Spleen, benefit the Stomach, resolve Dampness, stop diarrhea
 * Herbal Treatment:** Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Powder)

Diarrhea Manifesting As Spleen and Kidney Yang Vacuity
Bu Gu Zhi (10g.), Wu Zhu Yu (3g.), Wu Wei Zi (6g.), Rou Dou Kou(10g.)]
 * Signs:** watery diarrhea with undigested food that occurs at dawn, bowel movement preceded by cold abdominal pain that is relieved after diarrhea
 * Symptoms:** aversion to cold, cold limbs, sore, cold and weak lower back and knees
 * Tongue:** pale with a white coating
 * Pulse:** deep, fine, weak
 * Herbal Treatment:** Si Shen Wan (Four Spirits Pill)

Acupuncture for Diarrhea

 * Primary Points:** ST 25, ST 36
 * Supplementary Points:**
 * Cold-Damp:** CV 12, CV 6, SP 9
 * Damp-Heat:** ST 44, SP 9, LI 11, ST 37
 * Food Stagnation:** Inner Neiting, CV 10
 * Liver-Spleen Disharmony:** BL 18, LV 3, LV 13, CV 12
 * SP Qi vacuity:** CV 12, BL 20, SP 3, GV 20
 * SP/KI Yang vacuity:** CV 4, GV 4, BL 23, KI 3, BL 20

Clinical Tips for Treating Diarrhea
Excessive Dampness and Spleen vacuity are the two major proximal causes of diarrhea and have a tendency to influence each other. Damp accumulation can hinder the function of the Spleen, causing diarrhea; the treatment principle in such case emphasizes the action of expelling pathogenic factors. Therefore, bitter, warm and aromatic herbs should be used to dry Dampness. A vacuous Spleen may generate internal Dampness, causing diarrhea. The treatment principle in this case focuses on supporting Upright Qi; sweet, warm herbs should be used for strengthening the Spleen to stop diarrhea.

The underlying cause of diarrhea in each case should be taken into consideration when forming the treatment plan. In acute onset diarrhea, the method of binding and astringing is not recommended as a strategy as this may retain pathogenic factors. In cases of chronic diarrhea, apply the strategy of astringing and binding, and consider the method of raising Yang Qi.

With proper treatment, most cases of diarrhea resolve in a few days; however, inappropriate treatment can prolong recovery and lead to chronic diarrhea. Pathological crisis related to diarrhea is rare. However, severe, excessive and unremitting diarrhea will lead to severe loss of Yin and body fluids, resulting in depletion of Yin and devastation of Yang. Clinical manifestations of such a crisis include intense thirst with desire to drink, profuse leading and cold extremities, pale complexion and minute pulse. Biomedically, this is termed a fluid and electrolyte imbalance.



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============================================= =Potential Contributing Factors= Dysbiosis Magnesium Excess Potassium Excess

=Potential Secondary Effects= hypokalaemia

=Treatment=

Recommended Minerals
-Sodium -Potassium -Chlorine (persistant)

Orthomolecular Treatment
-Active Lb.

Phytotherapeutic Recommendations
-Vinca Minor (Periwinkle)

Prescription (Following Antibiotic Treatment)
Morning: Vaccinum Vitis Idaea D1, 50 drops Evening: Juglans D1, 50 drops