Diarrhea
Diarrhea refers to abnormal frequency and liquidity of fecal discharges . It
is usually due to disorders of the spleen , stomach , large and small intestines .
In light of the manifestations of the disease and the course , it is clinically
divided into acute and chronic . The former is mostly caused by indigestion due
to excessive eating or improper diet and attack of external cold dampness ,
leading to dysfunction in transmission of intestinal contents , or caused by
invasion of damp heat in summer or autumn ; the latter is caused by deficiency of
the spleen and stomach , leading to failure in transportation and transformation .
It is essential to distinguish diarrhea and dysentery .
Etiology and Pathogenesis
The causative factors are functional disturbance of the spleen and stomach
is inevitably involved pathogenetically . The stomach dominates receiving food
while the spleen dominates transportation and transformation . In case the
spleen and stomach are diseased , the normal digestion and absorption of food
is impaired , leading to mixing of food essence and wastes . When they descend
through the large intestine , diarrhea occurs .
As to the factors of diarrhea due to functional disturbance of the spleen
and stomach , there are many as follows .
Diarrhea may be caused by the six exogenous pathogenic factors , among which
mostly by cold , dampness and summer heat . The spleen is in preference to
dryness but dislikes dampness , which usually causes diarrhea . Besides the
superficial portion of the body and the lung , the stomach and intestines may
be affected by the pathogenic cold or summer heat , resulting in diarrhea .
In the latter case , however , the diarrhea is also often related to
dampness .
Excessive intake of food , particularly greasy food , leading to impairment
of the stomach and spleen in transportation and transformation , or eating of
raw , cold , dirty food , injuring the spleen and stomach , all bring about diarrhea .
Diarrhea may also be caused by weakened function of the spleen and stomach
due to irregular daily life or other factors . Since the spleen has the
function in transformation and transportation , diarrhea may occur if this
function is affected .
The spleen yang is closely related to the kidney yang . The fire of Mingmen
( Vital gate ) ( kidney yang ) may help the spleen and stomach to digest and
transform food into chyme . In case the kidney yang is weak , the spleen
yang is weak as well and fails to digest and transform food into chyme , thus diarrhea
occurs . Zhang Jingyue said : The kidney is the passgate of the stomach
and makes the urino - genital orifice and the anus as its openings . The passing
of both urine and stool is dominated by the kidney . Now the kidney yang is
weak , leading to decline of Mingmen ( Vital gate ) fire , and excess of cold ;
therefore , diarrhea occurs .
Differentiation
Acute diarrhoea
Cold - dampness :
Main manifestations : Watery diarrhea , abdominal pain and borborygmi ,
chilliness which responds to warmth , absence of thirst , pale tongue , white
tongue coating , deep , slow pulse .
Analysis : When the cold - dampness attacks the stomach and the
intestines , disturbing the function of the spleen in sending food essence
and water upward and that of the stomach in sending the contents downward ,
the food essence and the waste can not be separated , moving downward
together through the large intestine , so watery diarrhea with borborygmi
occurs . If the qi of the stomach and intestines is stagnated , abdominal
pain appears . Cold - dampness is a combination of yin pathogenic factors and
easy to damage yang qi . When yang qi is blocked , chilliness which responds
to warmth and absence of thirst occur . Pale tongue , white tongue coating ,
and deep , slow pulse are the signs of excess of internal cold .
Damp heat :
Main manifestations : Diarrhea with abdominal pain , yellow , hot and
fetid stools , burning sensation in the anus , scanty urine , or accompanied
by general feverish feeling , thirst , yellow , sticky tongue coating ,
rolling and rapid pulse .
Analysis : When the intestines and stomach are attacked by the damp heat
in summer or autumn , the transmitting and transformation function is
disturbed , and diarrhea appears . If the damp heat pours down , diarrhea
happens as soon as the abdominal pain is brought about . If the heat stays
in the intestines , there appear diarrhea with yellow , hot and fetid stools
and burning sensation in the anus . When excessive heat evaporates the
dampness , there are scanty urine , general feverish feeling and thirst .
Yellow , sticky tongue coating , and rolling , rapid pulse are the signs of
excess of damp heat .
Retention of food :
Main manifestations : Abdominal pain relieved after bowel movements ,
borborygmi , diarrhea with fetid stools , epigastric and abdominal fullness
and distension , belching , anorexia , thick filthy tongue coating , rolling ,
rapid or deep , string - taut pulse .
Analysis : Retention of food impairs the stomach function in sending its
contents downwards and the transmitting function of the intestines , so
there are epigastric and abdominal fullness and distension , abdominal pain
and borborygmi . After the undigested food turns putrid , diarrhea with
offensive fetid stools , belching and anorexia occur . After the wastes are
discharged , abdominal pain relieves . Thick filthy tongue coating , and
rolling , rapid or deep , string - taut pulse are the signs of retention of
food .
Chronic diarrhea :
Deficiency of the spleen :
Main manifestations : Loose stool with undigested food , anorexia ,
epigastric distress after eating , sallow complexion , lassitude , pale
tongue , white tongue coating , thready , forceless pulse .
Analysis : In case of weakness of the spleen and stomach , the spleen qi
fails to ascend and digestion is impaired ; therefore , loose stool with
undigested food appears . As the weakened spleen fails to digest and
transport the food , anorexia and epigastric distress after eating occur .
Persistent diarrhoea further weakens the spleen and stomach , affecting the
production of food essence and formation of qi and blood , and thus
resulting in the sallow complexion and lassitude . Pale tongue , white
tongue coating , and thready , forceless pulse are the signs of weakness of
the spleen and stomach .
Deficiency of the kidney :
Main manifestations : Pain below the umbilicus , borborygmi and diarrhea
usually occurring at dawn , relieved after bowel movements , and aggravated
by cold , abdominal distension sometimes , cold lower extremities , pale
tongue , white tongue coating , deep , forceless pulse .
Analysis : Pain below the umbilicus and diarrhea with borborygmi at dawn
are due to hypoactivity of the kidney yang and the declined Mingmen fire . :
Yin should be at maximum in case yang qi is not restored . The
stomach fails to hold its contents because of the declined Mingmen fire ,
thus diarrhea results . Abdominal aversion to cold , and sometimes distension ,
cold lower , extremities , pale tongue , white tongue coating , deep ,
forceless pulse are the signs of deficiency of the yang qi in the spleen
and stomach .
Treatment
Acute diarrhoea :
Method : The points of the Yangming Meridian of Foot are selected as the
principal points .
Cold - dampness : Reducing method in combination with moxibustion ( with
ginger ) ie applied to warm the stomach and resolve dainpoess .
Damp heat : Reducing is used to eliminate best and dampness . Retention of
food : Reducing is used to the function of the spleen and remove
stagnation . Prescription :
Supplementary points : Tianshu ( S 25 ) , Zusanii ( S 36 ) .
Cold dampness : Zhongwan ( Ren 12 ) , ( Ren 6 ) . Neiting ( S 44 ) , Yinlingquan Sp9 ) .
Retention of food : Inner - Neiting ( Extra )
Explanation : Tianshu ( S 25 ) , the Front - ( Mu ) point of the large intestine
is applied to segufate the transmitting function of the intestnes . Zusanii
( S 36 ) , the He - ( Sea ) point of Yangming Meridian of Foot , is used to ljust
the flow of the stomach qi . moxibustion to Zhongwan ( Ren 12 ) and ii ( Ren 6 )
is applied to warm the spleen and stomach , dispel cold , regulate the flow of
qi and resolve dampness . Neiting ( S 44 ) and Yinlingquan ( Sp 9 ) are needled
to eliminate damp - heat from the large intestine . For retention of food ;
Inner - Neiting ( Extra ) is used to regulate the function of the spleen and
stomach and remove retention .
Chronic diarrhoea :
Deficiency of the spleen :
Method : The points of the Spleen Meridian and some other points
concerned are selected as the principal points with the reinforcing method
and moxibustion to strengthen the function of the spleen and stop diarrhea .
Prescription : Pishu ( B 20 ) , Zhangmen ( Liv 13 ) , Taibai ( Sp 3 ) , Zhongwan
( Ren 12 ) , Zusanii ( S 36 ) .
Explanation : Pishu ( B 20 ) , a Back - ( Shu ) point of the spleen , Zhangmen ( Liv
13 ) , the Front - ( Mu ) point of the spleen , Taibai ( Sp 3 ) , the Yuan - ( Primary )
point of the Spleen Meridian , in combination with Zhongwan ( Ren 12 ) the
Front - ( Mu ) point of the stomach , and Zusanii ( S 36 ) , the He - ( Sea ) point of
the Stomach Meridian , are needled with moxibustion to invigorate the
spleen yang , strengthen the function of transportation and transformation
and stop diarrhea .
Deficiency of the kidney :
Method : The points of the Kidney Meridian , Ren and Du Meridians are
selected as the principal points with the reinforcing method and
moxibustion to warm and reinforce the kidney yang .
Prescription : Shenshu ( B 23 ) , Pishu ( B 20 ) , Mingmen ( Du 4 ) , Guanyuan ( Ren
4 ) , Taixi ( K 3 ) , Zusanii ( S 36 ) .
Explanation : Shenshu ( B 23 ) is the Back - ( Shu ) point of the kidney and
Taixi ( K 3 ) is the Yuan - ( Primary ) point of the Kidney Meridian . Needling
to these two points with the reinforcing method can warm the kidney yang
and invigorate the kidney qi . Moxibustion to Mingmen ( Du 4 ) and Guanyuan ( Ren
4 ) is able to reinforce the Mingmen fire and strengthen the kidney yang so
as to warm the spleen and kidney and promote digestion . This is known as a
treatment of the root cause . Pishu ( B 20 ) and Zusanii ( S 36 ) are used to
strengthen the spleen function and stop diarrhea .
Remarks
This condition may be involved in acute and chronic enteritis , indigestion ,
intestinal parasitic diseases , diseases of the pancreas , liver and biliary
tract , endocrine and metabolic disorders , and neurotic troubles .
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