1. Diarrhea
What is diarrhea ?
Diarrhea is a generally unpleasant condition in which the sufferer has frequent watery, loose bowel movements.
Dehydration: means the body lacks enough fluid to function properly. Dehydration is particularly dangerous in children & the elderly.
General signs of dehydration include
thirst
less frequent urination
dry skin
fatigue
light-headedness
dark colored urine
Diarrhea—loose, watery stools occurring more than three times in one day—is a common problem that usually lasts a day or two and goes away on its own without any special treatment. However, prolonged diarrhea can be a sign of other problems. People with diarrhea may pass more than a quart of stool a day.
Diarrhea can cause dehydration, which means the body lacks enough fluid to function properly. Dehydration is particularly dangerous in children and the elderly, and it must be treated promptly to avoid serious health problems.
People of all ages can get diarrhea. The average adult has a bout of diarrhea about four times a year.

2. Etiology & Pathology
无湿不成泄

3. Type of diarrhea in TCM
Different types according to the organs: Stomach diarrhea 胃泄 Spleen diarrhea 脾泄 Small intestine diarrhea 小肠泄 Different type of diarrhea due to etiology: Cold diarrhea 寒泄 Fire diarrhea 火泄 Summer-heat diarrhea 暑泄 Food congestion diarrhea 食泄 Phlegm diarrhea 痰泄 Different type of diarrhea due to period Acute diarrhea 暴泄 Chronic diarrhea 久泄
火热泄泻： 必暴泻如注，内经云： 暴注下迫，皆属于火
食积致泻： 必泻下奇臭
感寒作泄： 多兼腹痛
肝木克土：痛一阵，泄一阵，泻后痛减

4. Main Points for differentiation <1> Chronic & Acute
<2> Excess or Def.
Diarrhea but normal digesting
Could be cured without treatment
Diarrhea, no appetite, & lose weight
Serious disease
Acute onset, short duration
Dampness
Chronic onset, long duration
Spleen or Kidney def.
Excess
Def.
Acute onset
Chronic onset
Short duration
Long duration
Frequent diarrhea
Intermittent diarrhea
abdominal pain with distention & tenderness
Pain with preference for pressing
Pain relieving after diarrhea
Pain exacerbation after defecation

5. <4> Diarrhea & Dysentery
<3> Cold or Heat
<4> Diarrhea & Dysentery
Cold
Heat
Property of stool
Loose, clear, cool or watery
Sudden, ropy & yellow stool, burning in the anus
Abdominal pain
Gurgling sound and cutting pain, relieve after heat application
Burning pain, paroxysmal diarrhea
Stool with food
With indigested food
Bad smell
Thirst
No thirst
Excessive thirst
Drink
Pain relieving after taking hot drink
Preference for cold drink
Urine
Clear
Scanty dark
Diarrhea
Dysentery
Gurgling sound, pain relieve after heat application
Pain exacerbation after defecation
Spleen ( middle Jiao )
Intestine (low jiao) No
Hematochezia with pura
Free Defecation
Paroxysmal & rectal tenesmus
Dampness due to spleen def.
Pathogen attacking

6. <5> Therapeutic Principle
Dampness
Dispel dampness & dry the spleen
Superficial sym.
Relieve exterior syn.
Heat
Clear away heat
Dyspepsia
Promote digestion
Protracted diarrhea
(deficiency of vital essence
Strengthen resistance of the body
Acute diarrhea
Avoiding using reinforcing method & astringing intestine method together
Chronic diarrhea
Should not adopt over clearing & removing method

7. Nine Methods to treat Diarrhea
Drain the dampness, promote the urination:
Lifting the Yang Qi: Chai Hu, Shen Ma, Qiang Huo, Ge Gen
Clear the Damp-heat with bitter & cold herbs
Treating the unstopped by unstopping: using the purgation to teat diarrhea caused by food stagnation.
Harmonize the middle Jiao with Sweet herbs
Astringent with sour herb : Wu Wei Zi, Wu Mei, Bai Shao
Dry the dampness in the spleen
Warm the kidney
Stable & Bind:
Si Shen Wan: Rou Dou Kou; Tao Hua Tang: Chi Shi Zhi
治法有九。
   一曰淡渗 使湿从小便而去，如农夫治涝，导其下流，虽处卑监，不忧巨浸。经云；治湿不利小便，非其治也。又云：在下者引而竭之是也。
.如何理解并运用“利小便则实大便”的治法？       湿邪是导致泄泻的重要病理因素，《素问 ·阴阳应象大论 》指出：“湿盛则濡泄，”王叔和《脉诀》在内经的基础上提出“湿多成五泄”，认为泄泻离不开湿，后世尚有“无湿不成泄”之说。验之临床，湿邪往往存在于泄 泻发病的始终，并与泄泻的病程、虚实有密切关系。一般认为暴泄实证多以湿盛为主，脾虚为次；久泄虚证多以脾虚为主，湿盛为次。故以运脾化湿作为治疗泄泻的 基本原则。运脾以补脾、健脾为基础，化湿包括芳香化湿、苦温燥湿、淡渗利湿等法。其中淡渗利湿使湿从小便而泄，适用于暴泄实证，湿盛困脾，小肠分清泌浊失 职，水湿直趋大肠，症见大便次数频繁，泻下清稀如水而小便短少，舌苔厚腻等，用淡渗利湿之法使小便通利而止泻，故曰：“利小便则实大便”。但这一治法不能 用于泄泻所有证候的治疗，特别是久泄虚证，淡渗太多易伤气耗阴，反而加重病情。《景岳全书 ·泄泻 》指出：“泄泻之病，多见小水不利，水谷分则泻自止，故曰治泄不利小水非其治也”。湿盛泄泻而见小便不利时，可行利小便而实大便之法，“治泄不利小水非其 治也”是有前提的。
    二曰升提 气属于阳，性本上升，胃气注迫，辄尔下陷，升、柴、羌、葛之类，鼓舞胃气上腾，则注下自止。又如地土淖泽，风之即干，故风药多燥，且湿为土病，风能胜湿，所谓下者举之是也。
    三曰清凉 热淫所至，暴注下迫，苦寒诸剂，用涤燔蒸，犹当溽暑淤蒸之时，而商飚飒然倏动，则炎熵如失矣。所谓热者清之是也。
    四曰通因通用: 疏利 痰凝气滞，食积水停，皆令人泻，随证祛逐，勿使稽留。经云：实者泻之。
临床多用于以下三个方面：
一是因食积造成肠胃消化功能失常所导致的食积泄泻，此症治疗绝不可单纯止泻，当用消导泻下药来祛除肠胃的积滞，方用保和丸、枳实 导滞丸加减；
二是邪热内结的“热结旁流”症，其症不见燥结不通，却泻出黄臭灼热的粪水，此症也不可止泻，当用大小承气汤加味以泻阳明结热；
三是常用于瘀滞 内停的崩漏等出血疾患，治疗不可塞血止血，当用活血化瘀止血法，以达瘀去新生血止之目的。
    五曰甘缓 泻利不已，急而下趋，愈趋愈下，泄何由止，甘能缓中，善禁急速，且稼墙作甘，甘为土味，所谓急者缓之是也。
    六曰酸收 泻下有日，则气散而不收，无能统摄，注泄何时而已，酸之一味，能收摄之权。经云：散者收之是也。
    七曰燥脾 土德无惭，水邪不滥，故泻皆成于土湿，湿皆本于脾虚，仓廪得职，水谷善分，虚而不培，湿淫转甚。经云：虚者补之是也。
    八曰温肾 肾主二便，封藏之本，虽属水，而真阳寓焉，少火生气，火为土母，此火一衰，何以运行三焦，熟腐水谷乎?故肾虚者必挟寒，脾虚者必补母。经云：寒者温之是也。
    九曰固涩 注泄日久，幽门道滑，虽投温补，未克奏功，须行涩剂，则变化不愆，揆度合节，所谓滑者涩之是也。
    已上九治，治泻之大法，至于先后缓急之权，岂能预设，须临证之顷，圆机灵变耳
附：七成腹泻并不需用抗生素 秋季

8. Tonifying but not too much sweet & warm
Cautions :
Tonifying but not too much sweet & warm
Clear damp-heat but not too much bitter & cold
Astringent & bind but not too early
Promote urination but not too much
而且对泄泻治疗禁忌的论述也非常深刻。如曰“补虚不可纯用甘温，太甘则生湿；清热不可纯用苦寒，太苦则伤脾；兜涩不可太早，恐留滞余邪，淡渗不可太多，恐 津伤阳陷。”验之临床，暴泄以湿盛为主，切不可因泻下急迫量多次频而急于止泻，妄投补涩，以免闭门留寇或留滞余邪，“陈莝去而肠胃洁”，邪去则泄泻自止。 久泄以脾虚为主，治法重补，但补虚不可纯用甘温，或过用阴柔滋腻，以免生湿碍脾。暴泻清热不可纯用苦寒，以防苦寒伤脾败胃；久泄化湿不可妄投分利，以免劫 伤阴液。
暴泻忌补涩， 久泻慎分利

9. 1). Cold-damp or wind-cold type
Treatment
Fulminating diarrhea
1). Cold-damp or wind-cold type
Signs & Symptoms:
Main Sym. : acute & fulminating attack, clear & dilute, even watery stool, sudden pain & diarrhea with bowel sound
Concurrent sym.: often combined with exterior sym. of wind-cold. Plus less appetite & distension of abdomen
Tongue: white greasy
Pulse: slow & weak
Treatment Protocol:
Removing dampness by diuresis
Relieving exterior sym
Dispel the cold
风寒之邪外袭肌表 --》寒邪内犯脾胃--》影响脾胃的升降功能--》泄泻
治疗在于外疏表邪，内和脾胃，以调升降
疏解表邪兼以升和， 温寒拈痛以止其泄

10. Huo Xiang Zhen Qi Powder
Formula:
Modifications:
Exterior cold:
-- Jin Jie, Fang Feng
Dampness, gurgling sound, difficulty with urine
-- Wu Lin San
Cold is more serious than damp
-- Gui Zhi, Gan Jiang, Ai Ye ( Li Zhong Wan)
Huo Xiang Zhen Qi Powder
Huo xiang
Zi Su
Bai Zhi
Jie Geng
Bai Zhu
Hou PU
Ban Xia
Shen Qu
Da Pu Pi
Fu Ling
Chen Pi
Da Zhao
Shen Jiang
Gan Cao
寒邪重： 舌苔白滑润，身痛腹痛，脉弦紧： 桂枝6， 干姜3， 艾叶3， 腹痛甚者，用理中丸
风邪重： 发热恶风，体痛头痛： 荆芥、防风、羌活、独活
若湿邪重： 胸脘满闷，四肢乏力，肠鸣漉漉，腹痛绵绵，得暖则寒，逢寒则急，大便如水，清淡稀冷，后坠不畅，时而呕恶， 面色淡黄，舌淡，苔白腻滑润，脉濡软或沉缓
陈皮、半夏、厚朴、茯苓
兼食滞不化： 苔白腻中根厚，脉濡软, 关尺滑甚： 焦三仙，若腹痛明显者，再加草豆蔻3，半夏10， 陈皮6， 佛手6
若外有风寒，内有蕴热，发热恶寒，体痛，并口干，心烦急躁，苔黄脉数： 去姜辛等辛温之药，加黄连6， 黄芩10， 若有积滞者，可加用槟榔10， 莱菔子10， 大黄1-2g
若久病脾虚： 舌淡胖，苔白滑润，脉濡软者： 加枳术丸10， 焦三仙10， 扶脾化滞

11. 2). Damp-heat or Summer heat type diarrhea
Treatment
Fulminating diarrhea
2). Damp-heat or Summer heat type diarrhea
Signs & Symptoms:
Main Sym. : immediate diarrhea after abdominal pain, acute & sudden diarrhea, yellow-brown stool with pretty bad odor, feeling of burning heat in the anus.
Concurrent sym.: restlessness, thirsty, short & scanty dark urine
Tongue: yellow greasy coating
Pulse: “slippery and rapid” or “weak & rapid”
Treatment Protocol:
Clear heat
Removing dampness
腹痛即泻，便色黄褐，状如藕泥，肛门灼热，略有下坠后重感， 小便短赤，口干欲饮，口淡无味，思凉而不欲饮，舌红，苔腻黄厚或滑，脉濡滑且沉数
治法： 芳香化浊， 苦泄坚阴以止泻

12. -- Shen Qu, Shan Zha, Mai Ya Wind-heat exterior sym.
Formula:
Modifications:
Dampness:
-- Yi Yi Ren, Hou Pu,
Food retention
-- Shen Qu, Shan Zha, Mai Ya
Wind-heat exterior sym.
-- Jin Yin Hua, Lian Qiao
Summer-heat exterior sym. Restlessness, thirsty, dark urine
-- Xing Jia Xiang Ru Yin, Liu Yi San
Ge Gen Qin Lian Tang
Ge Gen
Huang Qin
Huang Lian
Zhi Gan Cao
Xin Jia Xiang Ru Yin: Xiang Ru; Hou Pu, Bian Dou, Jin Yin Hua, Lian Qiao,
若暑热较重： 自汗烦渴， 面赤油垢， 脉洪有力，舌红，苔滑： 栀子6， 黄柏6， 白头翁10， 焦麦芽10
若热不重，湿象明显，头身困重，下泻不爽，腹痛阵作，有下坠后重感，舌苔润胖，脉沉软者，减少芩、连用量，加荆芥、防风、半夏、陈皮、冬瓜皮、车前子
若服寒剂过量，出现凉遏现象： 舌红或淡， 苔白腻滑浮黄，脉沉细或沉细数，可去寒凉药物，加桂枝， 防风， 草豆蔻，甚至用干姜， 附子以宣阳化郁，去其凉遏

13. 3). Improper diet (over eating)
Treatment
Fulminating diarrhea
3). Improper diet (over eating)
Signs & Symptoms:
Main Sym. : diarrhea after abdomen pain, and pain relieving after diarrhea.
Concurrent sym.:Fullness in stomach area, loss of appetite
Tongue: yellow greasy coating
Pulse: slippery and rapid
Treatment Protocol:
Removing dampness
Promoting digestion
食泄多因饮食不节，或饮食过量，停滞不化，或恣食肥甘，湿热内蕴，或误食生冷不洁之物，损伤脾胃，

14. white coating & slow pulse -- Ping Wei san
Formula:
Modifications:
Damp heat
-- Huang Lian, Huang Qin
white coating & slow pulse
-- Ping Wei san
Severe food retention, full stomach, diarrhea with discomfort
-- Da Huang, Zhi shi
Bao He Wan
Shen Qu
Shan Zha
Fu Ling
Ban xia
Chen Pi
Lian Qiao
Lai Fu Zi
若婴幼儿食泄： 仍当以疏风和胃为主，防风3， 荆芥炭5， 灶心土20， 配以消食化滞之品
若年高体弱： 可在输液同时，服用中药，但竣攻之药当慎用，可配以香砂枳术丸
若孕妇伤食： 怀孕6-7月者，不宜用峻攻大补之剂，以疏调为主。若在怀孕之初，或者习惯性流产者，忌用破气，破血，攻泄之药，可用紫苏叶，葛根，荆芥炭，黄连，黄柏，白术，灶心土30， 茯苓，焦三仙，鸡内金等以疏和安中
若久病脾胃虚弱者，可选用枳术丸加减，正气虚者加太子参

15. Treatment Chronic diarrhea 1). Spleen def. Signs & Symptoms:
Main Sym. : loose stool or watery stool diarrhea with indigested food
Concurrent sym.: lose appetite, uncomfortable in the stomach area after eating, especially diarrhea after eating greasy food. Sallow complexion, fatigue & weakness
Tongue: pale & enlarged body
Pulse: weak
Treatment Protocol:
Tonify Spleen Qi
脾阳虚， 脾胃虚寒： 面色萎黄，胃纳欠佳，食后脘腹胀满，四肢清冷不温，神倦疲乏，泻下稀淡，甚则完谷不化，臭味不浓， 腹痛喜温喜按，舌淡胖润腻，脉沉软无力
益气补中，升阳止泻： 党参、白术、茯苓、陈皮、半夏、扁豆、薏苡仁、大枣、升麻
脾虚挟湿：胸腹满闷，大便次数增多，泄泻便溏，面色淡黄，舌淡胖，苔白腻滑润，脉濡软，沉取无力，病已日久，正气不足
升阳化湿，扶助脾运： 羌活6， 防风6，升麻6，（以风胜湿，且升清阳）桂枝6，炮姜6，茯苓12，苍术4，白术4，灶心土30，炒关桂4
久泻滑脱：高年体弱，久泻不止，脱肛，少腹隐痛，神倦疲乏，动则气喘，泻后两目昏花，四肢麻木，舌淡胖润滑，脉沉微迟
升阳益气，少佐固涩： 升麻6，黄芪15，党参15，白术12，白扁豆30， 陈皮10， 山药30，灶心土60，茯苓15，诃子肉10

16. Rectocele due to sinking of Qi -- Huang Qi, Dang Shen
Formula:
Modifications:
Spleen Yang Def.
-- Fu Zi Li Zhong Tang
Rectocele due to sinking of Qi
-- Huang Qi, Dang Shen
Long time chronic, ( red thin tongue body + thin yellow greasy coating)
-- Shi Liu Pi, Wu Bei Zi, Shan Zha
cold limbs
Shen Ling Bai Zhu San
Ren Shen
Fu Ling
Bai Zhu
Jie Gen
Shan Yao
Bai Bian Dou
Lian Zi Rou
Sha Ren
Yi Ni Ren
脾阳虚， 脾胃虚寒： 面色萎黄，胃纳欠佳，食后脘腹胀满，四肢清冷不温，神倦疲乏，泻下稀淡，甚则完谷不化，臭味不浓， 腹痛喜温喜按，舌淡胖润腻，脉沉软无力
益气补中，升阳止泻： 党参、白术、茯苓、陈皮、半夏、扁豆、薏苡仁、大枣、升麻
脾虚挟湿：胸腹满闷，大便次数增多，泄泻便溏，面色淡黄，舌淡胖，苔白腻滑润，脉濡软，沉取无力，病已日久，正气不足
升阳化湿，扶助脾运： 羌活6， 防风6，升麻6，（以风胜湿，且升清阳）桂枝6，炮姜6，茯苓12，苍术4，白术4，灶心土30，炒关桂4
久泻滑脱：高年体弱，久泻不止，脱肛，少腹隐痛，神倦疲乏，动则气喘，泻后两目昏花，四肢麻木，舌淡胖润滑，脉沉微迟
升阳益气，少佐固涩： 升麻6，黄芪15，党参15，白术12，白扁豆30， 陈皮10， 山药30，灶心土60，茯苓15，诃子肉10

17. Treatment Chronic diarrhea 2). Kidney def. Signs & Symptoms:
Main Sym. : diarrhea before draw, loose stool, even with undigested food, and comfort after diarrhea
Concurrent sym.: soreness & cold pain in the lower back, aversion to cold, bowel sound, damp & cool scrotum in male, delayed menstrual cycle in female
Tongue: pale & enlarged body
Pulse: deep & slow
Treatment Protocol:
Warming the kidney
Strengthen the spleen
Stop the diarrhea

18. -- Chi Shi Zhi, Gan Jiang, Jin Mi (Tao Hua Tang)
Formula:
Modifications:
sinking of Zhong Qi:
-- Huang Qi, Dang shen
Spleen Yang Def.
-- Fu Zi Ling Zhong Tang
Kidney Yang Def.
-- Ba Ji Tian, Rou Gui
Blood stasis
-- Shao Fu Zhu Yu Tang
Encopresis
-- Chi Shi Zhi, Gan Jiang, Jin Mi (Tao Hua Tang)
Si Shen Wan
Bu Gu Zhi
Rou Dou Kou
Wu Zhu Yu
Wu Wei Zi
Sheng Jiang
Da Zhao

19. 3). Liver Qi attacking the spleen.
Treatment
Chronic diarrhea
3). Liver Qi attacking the spleen.
Signs & Symptoms:
Main Sym. : abdominal pain & diarrhea after emotional disorder, and slight relieving of abdominal pain after defecation, and diarrhea again after abdominal pain
Concurrent sym.: fullness in the chest & hypochondrium, belching, loss of appetite, bitter mouth & acid regurgitation, shallow complexion, tiredness & weakness
Tongue: reddish body, yellowish coating
Pulse: taut & fine
Treatment Protocol:
Depressing the hyperactive liver Qi
Strengthen the spleen
Stop the diarrhea

20. -- Wu Bei Zi, Wu Wei Zi, Mu Gua Tonify Sp.
Formula:
Modifications:
Liver Yin def.:
-- Wu Bei Zi, Wu Wei Zi, Mu Gua
Tonify Sp.
-- Fu ling, Bian Dou, Shan Yao
Depression
-- Yu Jing, He Huan Hua, Long Gu, Mu Li
Tong Xie Yao fang
Bai Zhu
Bai Shao
Fang Feng
Chen Pi
其他经验方： 荆芥炭10， 防风6， 黄芩10， 黄连10， 白芍12， 陈皮6， 灶心土30-60， 冬瓜皮30， 甘草6
（灶心土、冬瓜皮和胃止泻，且补性不大，防增肝热
若肝郁化热： 心烦梦多，舌红口干， 小便赤热，脉弦细数，可加白芍到15， 甘草到10， 另外用左金丸6-10g布包， 川楝子10，以泄肝热
若脾虚明显，食少，疲倦无力，色润，脉虚者： 香砂枳术丸
若血虚阴伤，口干，舌红而瘦，头晕眼花，面色无华，脉弦细： 当归、川芎、木瓜、白芍，以养血育阴
若兼有湿浊内阻： 紫苏叶10， 紫苏梗10， 防风6， 半夏10， 陈皮6， 大腹皮6

21. Huo Xiang Zheng Qi San藿香正气散 Wei Ling Tang 胃苓汤 Wu Mei Wan乌梅丸
Conclusion
Huo Xiang Zheng Qi San藿香正气散
Wei Ling Tang 胃苓汤
Wu Mei Wan乌梅丸
Zheng Ren Yang Zang Tang真人养脏汤
Ge Gen Tang葛根汤
藿香正气散： 湿滞中焦，升降失调： 脘腹胀满
胃苓汤证： 脾不运湿，清浊不分： 大便次数多，而且清稀 （或兼口渴、小便不利）
乌梅丸证： 疫邪侵犯胃肠： 久泻，大便有粘液，常兼腹痛
真人养脏汤证： 肠滑失禁： 急于入厕，但不后重，大便不稀
葛根汤证： 太阳与阳明合病，必自下利： 寒伤阳气，津气出入受阻： 患者常有感冒病史，感冒后出现慢性腹泻，甚至可以持续数年之久。
泄泻一症，风寒暑湿火热皆可致泻，尤其以湿邪为主因，所以不可一味补涩，若因迁延日久，就认为久泻必虚，过用补涩药，反而招致留邪，更难愈

22. Main complain: Chronic diarrhea for 4 years, getting worse in 1 month
Case History
1. male 32 years
First visiting:
Main complain: Chronic diarrhea for 4 years, getting worse in 1 month
Patient has suffered from chronic colonitis for 4 years, and symptoms has got worse for 1 month. He has to go to bathroom 3~4 times/day. Other symptoms like abdomen pain, loose stools with bloody mucus, prefer warm, bad appetite, thin body type.
Tongue: white greasy coating
Pulse: fine
TCM diagnose:
Spleen def. + Damp heat
Treatment protocol:
-- Clear away damp-heat
-- Strengthen spleen & harmonize the stomach
Formula:
Dang Shen 12, Cang Zhu 12, Bai Zhu 12, Gan Cao 10, Gui Zhi 10, Yuan Hu 12, Huang Lian12, Huang Bai12, Mu Xiang10, Chen Pi10, Bai Tou Weng12,
After the abdomen pain reduced, take away Xuan Hu
After the bloody mucus disappeared, take away Huang Lian, Huang Pai, Bai Tou Weng
Dang Shen15, Cang Zhu 12, Bai Zhu12, Fu Ling 15, Huai Shan Yao 15, Fu Shou 10, Rose 12, Ban Xia 12, Bai Shao12, Chi Shao12, Mu Xiang10, Gan Cao10

23. Case History
2. Male 67 years
First visiting:
Main complain: Loose stools & diarrhea for several months
weakness, thin body type, sore lower back, aversion to cold, night urination, bad appetite, go to bathroom 3~4 times/ day. Every morning, he has to go to bathroom first after getting up, then feel comfortable. Other symptoms like abdomen distention,
Tongue: thin white coating
Pulse: deep & fine
TCM diagnose:
Spleen & kidney Yang def.
Treatment protocol:
-- Tonify Spleen & kidney yang
Formula:
Dang Shen 15, Bai Zhu 12, Fu Ling 15, Shan Yao 15, Chen Pi 10, Ban Xia12, Lai Fu Zi12, Fu Shou 10, Bu Gu Zhi12, Rou Gui10, Tu Si Zi15, Gan Jiang 6

24. Main complain: chronic diarrhea for several years
Case History 3
1. Male 31 years
First visiting:
Main complain: chronic diarrhea for several years
Patient had diarrhea 3~4 times/day for years, most occurred after eating the food, also related with stress. Diarrhea always started with painful lower abdomen, and the pain released after the defecation. Diagnosed as IBS by the regular doctor.
Physical Exam: soft abdomen & no tenderness
Tongue: thin coating
Pulse: slightly wiry
TCM diagnose:
The hyperactive Liver Qi attacking the Spleen
Treatment protocol:
-- Depressing the hyperactive Liver Qi
-- Tonify Spleen
Formula:
Bai Zhu15g, Bai Shao 15g, Fang Fen 15g, Chen Pi 6g, Chai Hu 15g, Yan Hu Suo 15g, Wu Mei 10g, Wu Wei Zi 5g, Dang Shen 10g, Shan Yao 15g, Gan Cao 6g
蔡淦治

25. Main complain: chronic diarrhea for years
Case History 4
Female 71 years
First visiting:
Main complain: chronic diarrhea for years
Patient had bad digestion since she was young, easily got diarrhea after eating improper food or got cold. The symptoms got worse during these several months. Every morning, she had emergence to go to bathroom after getting up. 2~3 times a day, sometime with indigested food; also had sunk feeling on the lower abdomen; sore lower back and knees;
Tongue: swollen body with teeth mark, thin greasy coating
Pulse: fine
TCM diagnose:
Spleen & Kidney Yang deficiency
Spleen Yang sunk
Treatment protocol:
-- Warm spleen & kidney yang
-- Raising Spleen Yang to stop diarrhea
Formula:
Bu Gu Zhi 15g, Rou Dou Kou 10g, Wu Zhu Yu 10g, Wu Wei Zi 5g, Huang Qi 15g, Dang Shen 15g, Chao Bai Zhu 15g, Fu Ling 15g, Chai Hu 6g, Shen Ma 6g, Ge Gen 15g, Shan Zha 15g, Shen Qu 15g, Mai Ya 15g, Gu Ya 15g,
蔡淦治jiao Shou

26. Main complain: Frequent occurred diarrhea for 4 month
Case History 5
Male 89 years
First visiting:
Main complain: Frequent occurred diarrhea for 4 month
Patient had frequent diarrhea for 4 m, 6~7/day, with yellow watery like stools, abdominal distention, pain, and borborygmus, appetite is Ok; Swollen legs;Treated with warm kidney, tonfiy spleen, astrigent, raising Yang Qi, stop diarrhea herbs, no working.
Tongue: red body with less coating
Pulse: fine & weak
TCM diagnose:
Damp-water accumulating due to Yang Qi lose its function of transportation.
Treatment protocol:
-- Warm the Yang Qi
-- Drain the dampness
Formula:
Gui Zhi 10, Fu Ling 15, Zhu Ling 15, Ze Xie 15, Bai Zhu 15, Che Qian Zi 30, Niu Xi 15, Shi Liu Pi 15, Shan Zha 15, Shen Qu 15, Mai Ya 15, Gu Ya 15
蔡淦治jiao Shou
因为患者年近九旬，反复腹泻4月，粪便又呈水样，舌红苔少，脉细弱。故先前就诊时，医生将注意力集中在患者的这一派虚象上，认为其病机为老年肾亏，脾失温 煦，清阳不升，且因腹泻日久，耗伤阴液，故见舌红苔少。因此，予以健脾补肾，升阳止泻。当疗效不显时，又投以罂粟壳等收涩之品，但仍未见效。蔡教授体检发 现患者双下肢浮肿明显，再结合先前医生诊治失败的经验，考虑其病机可能为脾肾两虚，水湿内停，气化失司。选用仲景的“五苓散”温阳化气，利水渗湿，法从“ 利小便实大便”，再酌加收涩之品。一周后，收效显著。