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Overview

This is when you have shit that’s both more frequent than usual and more diluted than usual. There are many ways to categorize the causes of diarrhea, but I put it into three main cats:

1. Microbial
2. Bad digestive system

Microbial causes are a huge reason why people continue to poop funny.  A large proportion is due to bacteria, and this more so in the summer time. e.g. 大肠杆菌 (e. coli) that causes inflammation of the intestines and subsequent diarrheatic events. In the autumn season, it’s more like the the viruses that reign supreme, especially rotaviruses (轮状病毒) which must be the most common source of diarrhea - or is it? Rotaviruses are transmitted via the respiratory tract, and not the GI tract, and usually begin as fluish symptoms.

As for a bad digestive system, some people are just predisposed to having diarrhea. That’s their constitution. For example, kids don’t digest too well, or a person may be lactose intolerant (dearth of lactase 乳糖酶).

Chinese medicine’s strength is in treating a person’s constitutional weaknesss in the digestive area. There’s a saying “泄泻之本，无不由于脾胃。” It basically means that diarrhea has always to do with the Spleen-Stomach. We too can use Chinese medicine against acute attacks by micobial creatures, but have to note that the treatment is not single-pronged against one particular agent. rather, the herbs have a multipronged effect on different bacteria and viruses.

Diagnosis & Treatment

First, determine whether it’s acute or chronic.

Acute diarrhea can be divided into hot-type and cold-type. For the hot-type, the representative formula is 葛根芩连汤, many of whose agents will battle the foreign microbes. For the cold-type, 藿香正气散 is representative. to me, the inflammatory response is more katarrhic than say pruritic, hence it’s ‘cold’ nature. Quite some herbs in there are for resolving the exterior, hence any inference to it’s anti-viral capabilities is reasonable.

Both acute and chronic diarrhea could be due to stuff not digesting well. This is to say the foreign bodies are not the microbes, but rather the food itself. It’s worth mentioning though that it may be a constitutional deficit that cannot handle the food. We solve this by aiding digestion using 保和丸. Of course digestive enzymes have a similar function too.

With chronic diarrhea, Chinese herbs have a tonifying function, and this is where it strength shows. In tcm-talk, it’s first spleen qi, then spleen yang, then kidney yang that’s depleted. With spleen qi weakness, we can use 参苓白术散 as a representative formula to not just build spleen qi but also to take away damp (which is associated with diarrhea). It’s always nice to add stuff for the spleen yang when noticing it ailing too - herbs like 炮姜 4-5g, 砂仁 2-3g, 益智仁 10g will work. When kidney yang is deemed weak, then think 四神丸 which has spleen and kidney warming functions together with 附子理中汤 which is applied to interior coldness. Aconite dosage can begin at 4-5g at the beginning, and up-calibrated if deemed necessary. Add astringents like 赤石脂 and 诃子 only if you’re sure no toxins are going to be left in there.