Diarrhea Flashcards
Definition of diarrhea (Xie Xie). When to worry?
- Stools are loose and watery and may be more frequent than normal
- If it lasts more than 2 days it could be serious
- Can lead to malnutrition
- Short term and long term
Age and time of year most common?
Summer and Autumn
Under 2 years old
Organ locations for diarrhea?
Spleen
Kidneys
(In adults Liver as well)
Main symptoms of diarrhea
- Abdominal pain
- Bloody stools
- Cramping
- Dehydration (loss of BF)
- Fever
- Incontinence
- Nausea upset stomach
- Swelling
- Urgent need to go
Etiology/Pathogeny
- Spleen constantly deficient
- Easy to get external pathogen invasion
- Breast milk?
- Spleen and Yang Deficiency
- Excess of dampness
Pathogenesis
Spleen malfunction –> Excess damp –> Long term damage Yin and Qi –> Malnutrition
Factors to consider for diarrhea
- Bacterial infection
- Viral infection
- Food intolerances
- Food allergies (immune response)
- Parasites
- Reaction to medicine
- IBD inflammatory
- Functional bowel disorder IBS
- Surgery on ST or GB
Protocol of diagnosis
- Diet or recent common cold
- Frequent stools (more than often) dehydration, fever, vomit, thirst and pain in extreme case
- Stool evaluation for blood or fat
- Blood test to rule out certain diseases
- Imaging tests to rule out structural problems
- Tests to check for food intolerance or allergy
Exam: differentiate from dysentery
Amoebic dysentery: Diarrhea, High fever, Nausea and vomiting, Upset stomach, Weight loss
Bacillary dysentery: Cramps, Diarrhea with blood or mucus, High fever, Nausea and vomiting
Different from regular diarrhea: High fever, vomiting, blood and mucus
Syndrome differentiation categories broad
- Heat Damp
- Wind Cold
- Food Damage
- Spleen Xu
- Yang Xu
- Qi and Yin Damage
- Depletion of Yin and Yang
Diarrhea patterns specific
- Wind Cold Diarrhea
- Damp Heat Diarrhea
- Food Stagnation Diarrhea
- Spleen Deficiency
- Spleen and Kidney Yang Deficiency
- Exhaustion of Yin and Yang
Broad treatment principle for diarrhea?
- Tonify Spleen
- Regulate Spleen transporting and transforming function
- Transform dampness
Wind Cold Diarrhea S/S
S/S:
- Stools, thin and frothy with sl. foul odour
- Abdominal pain
- Aversion to cold
- Borborygmus
- Cough
- Fever
- Nasal discharge
- Tongue: pale with thin white coat
- Pulse: floating and tight
- Finger venules: pale and red
Wind Cold Diarrhea TXP and Formula
TXP:
- Expel wind
- Remove cold
- Eliminate damp
- Regulate MJ
Formula: Huo Xiang Zheng Qi San
Huo Xiang Zheng Qi San (Agastache powder to Rectify) ingredients, functions
- Huo Xiang (Agastache, Pogostemon, Patchouli, Giant Hyssop) Aromatically transform damp, Harmonize MJ, Release exterior
- Zi Su Ye (Perilla leaf) Release exterior, Disperse cold, Move SP/ST Qi
- Fang Feng (Sapashnikoviae) Expel Wind Cold, Relieve diarrhea
- Chen Pi (Tangerine peel) Regulate Qi, Tonify SP, Adjust middle, Dry damp, Transform phlegm
- Ban Xia (Pinellia) Transform phlegm, Dry damp, Descend rebellious Qi, Harmonize ST
- Fu Ling (Poria) Promote urination, Resolve damp, Strengthen SP, Harmonize MJ
- Zhi Gan Cao (fried licorice) Harmonize, Tonify SP and Qi
- Cang Zhu (Atractylode rhizome) Aromatically transform damp, Expel Wind Damp, Tonify SP
- Sheng Jiang (fresh ginger) Release exterior, Warm MJ, Adjust Ying and Wei
- Da Zao
Overall fx:
- Release exterior
- Transform damp
- Regulate Qi
- Harmonize MJ
5 Extra Herbs for W-C Diarrhea
- Bai Zhu (White Atractylodes) Tonify Qi, Strengthen T & T function of Spleen and dry damp
- Gui Zhi (Cinnamon bark) Disperse cold, Warm Yang, Release ext W-C
- Hou Po (Magnolia Bark) Dry dampness, Transform phlegm
- Ma Huang (Ephedra) Release ext, Warm cold, Circulate water
- Xiang Fu (Cyperus) Spread and regulate LR Qi, often used with Zi Su Ye for abdominal discomfort associated with externally contracted disorders
Damp Heat Diarrhea S/S
- urgent frequent bowel mvmt
- bouts of abdominal pain
- crying, dysphoria
- fever
- loss of appetite
- mucous possible
- nausea and vomiting
- thirst w/ desire to drink
- watery, cloudy loose bowels with foul odour
- yellow scanty urine
- Tongue: red with yellow greasy coat
- Pulse: slippery and rapid
- Finger: purple venules
-
Damp Heat Diarrhea TXP
Clear intestines
Relieve heat
Resolve dampness
Stop diarrhea
Damp Heat Diarrhea formula and overall function
Ge Gen Huang Qin Huang Lian Tang
Fx:
* Release exterior
* Clear internal Yangming heat
* Raise Yang to stop diarrhea
Ge Gen Huang Qin Huang Lian Tang ingredients and fx
- Ge Gen (Kudzu root) Release ext, Raise Yang, Neck/upper back muscle relax, Relieve Heat, Generate fluid
- Huang Qin (Scutellaria) Clear Lung heat, Drain Fire, Detoxify, Cool blood
- Huang Lian (Coptis rhizome) Drain Fire, Relieve toxicity, Clear Heart Fire, Drain Stomach Fire
- Zhi Gan Cao Harmonize other herb
5 extra herbs for Damp-Heat diarrhea
- Bai Tou Weng (Pulsatilla root) Herbs that* clear heat and dry damp*: Relieve fire toxin, Clear damp heat, Stop diarrhea
- Hou Po (Magnolia Bark) Dispel dampness, Harmonize Stomach, Regulate Qi
- Huang Bai (Phellodendron) Clear damp-heat from lower jiao, Clean heat, dry damp
- Qin Pi (Ash bark) Clear heat, Dry damp Astringe diarrhea, works well with Bai Tou Weng and Huang Lian
- Ze Xie (Alisma, Water Plantain) Drain dampness, Promote urination, Drain damp heat from LJ
Food Stagnation Diarrhea S/S
- Loose stool with food residue
- Stool with sour rotten egg odour
- Abdominal, epigastric distention/pain
- Belching with sour odour/vomit
- Desire for defecation, relieved after mvmt
- Distention/pain worse with pressure
- Poor appetite
- Restless at night
- Tongue: red with thick greasy coat
- Pulse: slippery and rapid
Food Stagnation Diarrhea TXP
Boost Spleen
Harmonize Stomach
Disperse food stagnation
Food Stagnation Diarrhea formula and fx
Bao He Wan
Preserve Harmony Pill
Citrus and Crataegus
Fx:
* Disperse food
* Harmonize Stomach
Bao He Wan ingredients and fx
- Shan Zha (Hawthorn Berry) Reduce all types food stagnation esp. meat and fat
- Shen Qu (Massa) Reduce food stagnation, Promote digestion, Reduce stagnant alcohol, Move Qi
- Lai Fu Zi (Radish seed) Descend Qi, Reduce accumulation of phlegm from grains
- Chen Pi (Tangerine peel) Regulate Qi, Adjust middle, Relieve diaphragm, Dry damp, Transform phlegm
- Ban Xia (Pinellia)* Descend Qi, Transform phlegm, Harmonize Stomach*
- Fu Ling (Poria) Drain damp, Harmonize MJ, Transform phlegm
- Lian Qiao (Forsythia) Clear heat stagnation
- Mai Ya (Barley Sprout) sometimes
5 Extra Herbs for Food Stagnation
- Chuan Xiong (Lovage root) Invigorate blood, Promote movement of Qi
- Mu Xiang (Aucklandia) Circulate Qi, Strengthen SP, Dispel damp-heat
- Qing Pi (Green tangerine peel) Spread LR Qi, Break up stagnant Qi, Reduce food stagnation, Dry damp
- Xiang Fu (Cyperus) Spread and regulate LR Qi
- Zhi Shi (unripe Bitter Orange) Regulate Qi, Break up stagnant Qi, Reduce accumulation, Transform phlegm
Spleen Deficiency Diarrhea S/S
- Diarrhea prolonged course without odour
- Diarrhea when eating too much
- Emaciation
- Listlessness
- Sallow complexion
- Tongue: pale with white coat
- Pulse: slow, weak
- Finger venules: pale
Spleen Deficiency Diarrhea TXP
- Tonify Spleen
- Regulate Spleen transporting function
- Transform dampness
Spleen Deficiency Diarrhea Formula and Functions
Shen Ling Bai Zhu San
Ginseng, Poria and Atractylodes Powder
Fx:
* Augments Qi
* Resolves damp
* Tonifies Spleen
* Stops diarrhea
Shen Ling Bai Zhu San ingredients and fx
- Ren Shen (radix Ginseng) Tonify Qi, Strongly tonify LU and SP Qi
- Dang Shen (Codonopsis) or Tai Zi Shen (Pseudostellaria) could be substitutes for Ren Shen
- Fu Ling (Poria) Drain damp, Transform phlegm,
- Bai Zhu (Atractylode macrocephalae) Tonify Qi, Tonify Spleen, Dry damp
- Zhi Gan Cao (baked Licorice) Tonify Qi, Harmonize, warm, strengthen MJ
- Chen Pi (Tangerine peel) Regulate Qi Dry damp, Transform phlegm
- Shan Yao (Chinese Yam) Tonify Qi Tonify SP, Nourish ST and KI yin
- Sha Ren (Cardomom) Transform dampness (aromatically), Warm middle, Stop diarrhea, Mvmt Qi, Strengthen SP
- Yi Yi Ren (Coix seed) Resolve dampness, Strengthen SP,
- Bai Bian Dou (Hyacinth bean) Clean heat, Purge fire Resolve dampness, Strengthen SP
5 Extra herbs for Spleen Deficiency diarrhea
- Ban Xia (Pinellia) Drain dampness, Harmonize ST, Transform phlegm
- Long Yan Rou (Longan fruit) Strengthen SP and HT, Tonify Blood
- Mu Xiang (Aucklandia) Strengthen Spleen, Regulate Qi, Dispel Damp-heat
- Tai Zi Shen (Pseudostellaria) Strengthen SP, Tonify Qi
- Ze Xie (Alisma, Water Plantain) Resolve damp, Strengthen SP, Harmonize ST, Transform phlegm
KI and SP Yang Deficiency Diarrhea S/S
- Chronic diarrhea w/ thin, clear stools
- Cold body and limbs
- Listlessness
- Possible prolapse rectum
- Pale complexion
- Sleeping with eyes slightly open
- Undigested food
- Urine clear
- Tongue: pale with white coat
- Pulse: weak and thready
- Finger: light coloured venules
SP & KI Yang Xu diarrhea TXP
- Warm and boost SP and KI
- Astringe intestines to stop diarrhea
SP & KI Yang Xu diarrhea main formula and fx
Fu Zi Li Zhong Wan
Prepared Aconite Pill to Regulate the Middle (Aconite, Ginger, Ginseng)
Fx:
* Warms Yang
* Dispels cold
* Strengthens Spleen
* Tonifies Qi
SP & KI Yang Xu diarrhea second formula and fx
Si Shen Wan
Four Miracle Pill
Fx:
* Warm and tonify SP & KI
* Astringe intestines
* Stop diarrhea
Fu Zi Li Zhong Wan ingredients and fx
- Bai Zhu (white Atractylodes) Tonify Qi, Tonify SP, Dry dampness
- Gan Jiang (dried ginger) Warm interior SP/ST, Eliminate Cold
- Ren Shen (Ginseng) Tonify Yuan Qi, Reinforce Yang, Harmonize MJ
- Zhi Fu Zi (Aconite) Warm interior (SP), Expel cold, Restore KI and HT Yang, Relieve pain, Dispel damp
- Zhi Gan Cao (Licorice) Tonify Qi of MJ and Harmonize
Si Shen Wan ingredients and fx
- Bu Gu Zhi (Psoralea) Tonify Yang, Tonify KI, Tonify and warm SP, Stop diarrhea, Treat Mingmen Xu fire
- Rou Dou Kou (Myristica, Nutmeg seed) Astringe intestines, Warm MJ, Stop diarrhea, Treat daybreak diarrhea from SP/KI Yang Xu
- Wu Wei Zi (Schisandra) Astringe to stop diarrhea, Replenish Qi
- Wu Zhu Yu (Evodia) Warm MJ and SP, Disperse cold, Stop diarrhea, Dry damp
- Sheng Jiang
- Gan Cao
Combination formula ingredients for SP/KI Yang Xu diarrhea?
- Fu Zi
- Dang Shen
- Bai Zhu
- Gan Jiang
- Bu Gu Zhi
- Rou Dou Kou
- Wu Zhu Yu
- Wu Wei Zi
5 extra herbs for SP/KI Yang Xu diarrhea
- Ge Gen (Kudzu root) Raise SP Yang, Stop diarrhea
- Huang Jing (Polygonati) Tonify SP Qi, Tonify Kidneys, Strengthen Jing
- Lian Zi (Lotus seed) Stabilize and bind, Tonify SP and KI, Astringes Jing
- Tai Zi Shen (Pseudostellaria) Strengthen SP, Tonify Qi
- Tu Si Zi (Cuscuta seed) Strengthen Yang, Astringe Jing, Tonify Ki and SP, Stop diarrhea
Exhaustion of Yin and Yang S/S
- Diarrhea, continuous and profuse
- Apathy
- Cold limbs
- Listlessness
- Pale or grey-green complexion
- Scanty or no urine
- Weak crying without tears
- Tongue: pale and dry
- Pulse: deep, thready and feeble indicating critical condition
Exhaustion of Yin and Yang diarrhea, which two formulas combined?
Shen Mai San
Shen Fu Long Gu Mu Li Tang
Fx:
- Return Yang
- Strongly strengthen Yuan Qi
- Restore Yin
- Anchor the spirit
Exhaustion of Yin and Yang diarrhea ingredients and fx
- Ren Shen (Ginseng) Tonify Qi
- Mai Men Dong (Ophiopogon) Tonify Yin, Generate fluid
- Wu Wei Zi (Shisandra) Astringe Jing, Tonify KI, Stop diarrhea, Tonify Qi
- Fu Zi (Aconite) Restore devastated Yang, Rescue from rebellion, Warm Ming Men Fire, Assist HT, KI, SP Yang, Warm interior, Disperse cold
- Pao Jiang (Dried ginger) Rescue devastated Yang, Warm Middle, Expel Cold
- Long Gu (Dragon Bone) Anchor and preserve floating Yang, Calm spirit, Calm Liver
- Mu Li (Oyster Shell) Anchor floating yang, Benefit Yin, Calm spirit, Calm Liver
Acupuncture points for diarrhea
- EX-UE-10
- RN10
- RN12
- LI11
- ST25
- ST36
- BL20
- PC6
Which points for moxibustion?
- RN12
- ST36
- RN8
Sì Fèng
M-UE-9
(EX-UE-10)
applicable to diarrhea
Four Seams
Overall: Tonifies SP/ST, reduce accumulations, Good for malnutrition
Good for:
Food Stagnation
Spleen Deficiency
SP & KI Yang Deficiency
CV10 Xià Wãn
Lower Stomach
Sedating
Intersection of RN and SP
VIP for gastric pain and diarrhea
Especially good for vomiting food stagnation
Assist movement and transformation in ST and Intestines
Good for EXCESS situation (W-C, D-H, Food stagnation)
Support SP (but not really tonify)
CV12 Zhōng Wãn Central Stomach
Tonifying
Front Mu of ST
Influential Point of Fu Ogans
- Harmonize Stomach (descend ST Qi, food stagnation for Xu or Excess)
- Fortifies SP and transforms damp for Xu
Could use for all 6 patterns
LI11 Qū Chí
Pool at the Bend
Earth
He Sea
Mother reinforcing pt
Ghost pt
- Eliminate wind and ext. (W-C, D-H)
- Cool pathogenic heat (D-H)
- Open joints
- Resolve damp (D-H, all patterns)
- Regulate blood flow
Good for all patterns. Can treat both excess and def.
ST25 Tiān Shū
Celestial Pivot
Front Mu of LI
- Regulate fx of intestines (all)
- Relieve food accumulation (Food Stag)
- Support earth and transform damp from SP Xu
- Clear ST or LI heat (D-H)
ST36 Zú Sān Lî
Leg Three Mile
Earth, He Sea
Tonifying
Lower He Sea ST
Command of Abdomen
Sea of Water and Grain
All points
- Benefit ST/SP
- Harmonize intestines, disperse stagnation (Food stag)
- Tonify Qi and blood (post heaven Qi)
- Dispel pathogens and build immunity, yuan Qi, pre heaven Qi
- Course wind and transform damp (W-C, D-H)
BL20 Pí Shū
Back Shu SP
Spleen Shu
Tonifying
- Regulate SP Qi
- Assist T & T
- Support earth and eliminate damp
- Nourish blood
All patterns except maybe W-C, D-H
PC6 Nèi Guān
Inner Pass
Sedating
Luo Connecting PC
Confluent Yin Wei
Command pt for HT, Chest, Epigastrium
- Calm heart and spirit
- Relax chest and regulate qi
- Suppress rebellious Qi and stop vomiting
- Suppress pain
Any pain in Stomach
CV8 Shén Què
Spirit Tower Gate
- Warm and restore Yang Qi (SP Xu, SP & KI Yang Xu, Yin and Yang Exhaustion)
- Strengthen SP
- Regulate intestines
If there is diarrhea and bloating, what are the likely syndrome?
- Cold
- Yang Deficiency
- Damp Heat
If there is diarrhea and nausea, what are the likely syndromes?
- Heat signs, damp heat, will affect the movement of Qi and cause nausea
- Food poisoning or toxins
If it is Liver Overacting on Spleen what kind of diarrhea? When will they feel better?
Bonus: Formula?
They will often have explosive diarrhea and will feel better right after.
Tong Xie Yao Fang (Bai Zhu Shao Yao San) “Important Formula for Painful Diarrhea”
Best points for malnutrition?
LU10 (LI10?) and Si Feng
Can bleed them but not a lot of blood.
If there is diarrhea and an external pathogen which do you treat first?
BOTH at the same time. Never treat diarrhea without treating external pathogen if it is present.
