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After the Dragon Boat Festival, cases of diarrhea often increase.Diarrhea can vary in severity. Proper differentiation and treatment can lead to quick recovery, while improper handling may result in serious consequences.From a TCM perspective, it is essential to first distinguish between cold and heat patterns in diarrhea.If the primary cause is cold, warming the middle jiao (zhong jiao) is necessary; sometimes a hot water bottle can quickly resolve the issue. If it is simply due to food stagnation with internal heat, then addressing the food stagnation is crucial; once the food is expelled, the stomach will settle. Cases accompanied by cold dampness or damp-heat, as well as mixed cold and heat diarrhea, require more complex differentiation and treatment.Today, we will look at a case of diarrhea with mixed cold and heat symptoms.Let’s examine the ten questionsChief Complaint:A child aged two years and four months initially had a fever, which subsided after medication, but then developed diarrhea. The primary concern now is to address the diarrhea.Stool: 3 to 4 times a day, yellow and unformed, without sour or foul odor; the first stool was unformed, and the subsequent one was particularly watery, sometimes resembling egg drop soup. This morning, the child had a bowel movement once, and within half an hour, had two more small ones, resembling dysentery with a bit of red blood streaks.The stool being yellow and unformed, sometimes resembling egg drop soup, indicates a deficiency-cold pattern in the Taiyin (太阴) organ system. The presence of red blood streaks suggests the possibility of internal heat. Based on the stool, this is a case of mixed cold and heat.Urine: 3 to 4 times a day, yellow and scant.The yellow and scant urine may be due to diarrhea causing fluid loss, and it is important to consider water intake; the child reportedly likes to drink water, which may indicate internal heat in the Yangming (阳明) organ system.The child usually does not drink much water, but since the diarrhea began, has been particularly thirsty for warm water.Previously not fond of drinking water, the child now drinks more due to dry mouth, indicating a deficiency of fluids, which is a sign of internal heat in the Yangming system. The preference for warm water suggests a deficiency-cold pattern in the Taiyin system.At night, the child prefers to sleep on their stomach or side, does not like to cover with a blanket, and sometimes sleeps with their buttocks raised, tossing and turning, and is not very stable, often kicking off the blanket.Stomach discomfort and restless sleep reflect issues with the middle jiao and spleen-stomach. The preference for stomach sleeping suggests a deficiency-cold pattern in the Taiyin system. The raised buttocks and restlessness may indicate gastrointestinal stagnation or heat, or deficiency-cold in the middle jiao.In the past two days, the child’s appetite has not been very good.Poor appetite is evidence of deficiency-cold in the Taiyin system; the gastrointestinal motility is focused on addressing diarrhea, leaving insufficient qi and blood to digest food.Usually does not sweat much, only sweats after vigorous exercise, and does not sweat at night.The local weather is not very hot, so the lack of sweating is considered normal.The child’s spirit is okay, but this morning was particularly clingy, complaining of stomach discomfort.Being clingy in the morning and complaining of stomach discomfort suggests that diarrhea has consumed a significant amount of the body’s qi and fluids, leading to poor gastrointestinal function and digestive issues in the middle jiao, indicating a Yangming-Taiyin pattern.The fever lasted for one day, with hot sensations in the soles of the feet, palms, back, abdomen, and neck. The fever started on Monday night, reaching 38.2 degrees Celsius, and subsided by the next afternoon. The mother suspected food stagnation and gave the child Baohe Granules and Xiao Chai Hu Decoction; after the fever subsided, only Baohe Granules were given. No medication was used after the diarrhea began.The mother did not describe the temperature differences in the body parts at that time, which can be disregarded. The abdominal distension is likely due to qi stagnation in the middle jiao caused by food accumulation.
The tongue coating is thick and greasy in the middle and back, with some areas showing a peeled coating, indicating moisture.The moist tongue surface indicates a deficiency-cold pattern. The peeled coating suggests damage to the stomach yin, indicating insufficient stomach fluids. Combined with the ten questions, the peeled coating is currently caused by heat. The thick and greasy tongue coating indicates a significant amount of internal waste, reflecting a mixed cold and heat pattern.This is a case of diarrhea with more cold than heat.Based on the ten questions and tongue coating, it can be seen that the child’s middle jiao is predominantly deficient-cold, and after diarrhea, symptoms such as dry lips and increased thirst indicate heat signs. There is evidence of both cold and heat, suggesting that the middle jiao is in a mixed cold and heat state. There is no evidence of food stagnation, so this heat is not due to excess Yangming heat but rather due to insufficient fluids leading to internal heat.Therefore, when addressing this issue, it is necessary to care for the deficient-cold middle jiao, warm and strengthen it, while also clearing some heat and replenishing fluids.Six-category differentiation: Yangming-TaiyinYangming: dry lips, increased thirst, peeled tongue coating, scant yellow urine, stool resembling dysentery with blood streaks.Taiyin: unformed stool 3 to 4 times a day, no foul odor, thick and greasy tongue coating, abdominal discomfort, preference for stomach sleeping, poor appetite.Treatment suggestion: Gan Cao Xie Xin Tang (Licorice Decoction) (Zhi Gan Cao, Jiang Ban Xia, Gan Jiang, Huang Qin, Huang Lian, Dang Shen, Da Zao).In this formula, Zhi Gan Cao, Gan Jiang, and Da Zao warm and strengthen the middle jiao, while Huang Qin and Huang Lian can clear heat, and Dang Shen helps replenish fluids.
(This suggestion is for learning and communication purposes only and is not the best recommendation. To ensure medication safety, it is strictly prohibited to apply symptoms without proper differentiation.)
After one dose of medication, feedback: the child did not have diarrhea all day after taking the medicine.From the ten questions, there is no significant evidence of food stagnation; the mother’s later use of Baohe Granules may indicate a possibility of misdiagnosis and overmedication. Therefore, when symptoms arise, it is essential to remain calm, observe the child’s eating, drinking, bowel movements, and sleep, and use medication based on the child’s current condition after proper differentiation. Without the ability to differentiate cold and heat, deficiency and excess, one should not blindly use medication and may seek a doctor’s help.When the differentiation is correct, the medication will have immediate effects. Based on the child’s tongue coating, there is still a peeled coating, indicating that the spleen and stomach are generally weak, and the stomach qi is insufficient. Medication can be used for two to three days to better assist the recovery of the spleen and stomach.Finally, let’s reviewGeneral differentiation of diarrhea:1. Diarrhea due to food stagnation:This occurs due to excessive food intake beyond digestive capacity, which may be accompanied by hot sensations in the palms, yellow-white thick tongue coating, bad breath, foul-smelling stool, dark stool, increased thirst, abdominal distension, poor appetite, etc.Diarrhea due to food stagnation is a way to expel accumulated waste from the body, so it should not be stopped; instead, it is necessary to aid digestion and expel waste. For dietary therapy, Jiao Mi Tang (焦米汤) can be used, and for Chinese patent medicine, Baohe Wan (保和丸) can be considered.2. Diarrhea caused by pure cold:This occurs due to external invasion of wind-cold or consumption of cold food, leading to cold in the middle jiao and spleen-stomach, which may also be accompanied by cold symptoms such as sneezing, runny nose, cough, watery green stools, without odor or fishy smell. The tongue coating is generally thin white, moist, and slippery, and the hands and feet may feel cool, with a cold abdomen.Diarrhea due to cold dampness requires warming the middle jiao and dispersing cold, ensuring the child’s abdomen is warm. It is also important to replenish fluids to prevent dehydration, which can be aided by Nanhuaijin (南怀瑾) belly stickers, moxibustion, etc. For medication, Li Zhong Wan (理中丸) can be considered for milder cases, and Huo Xiang Zheng Qi Ye (藿香正气液) for more severe cases.3. Diarrhea caused by damp-heat:This occurs when there is dampness and heat in the body, which may be accompanied by urgent bowel movements, burning sensations in the anus, foul-smelling stools, and difficulty in defecation, along with symptoms of irritability, thirst, and yellow urine. The tongue may appear red, and the coating may be yellow and greasy, indicating heat signs.For damp-heat diarrhea, it is necessary to clear heat and dry dampness. For dietary therapy, red bean and coix seed water can be used, and for significant damp-heat, Compound Huanglian Su Pian (复方黄连素片) can be considered.Note: During diarrhea, dietary considerations should focus on light foods. One should not overload the child with food due to concerns about nutritional loss; the middle jiao and spleen-stomach are already weak and unable to digest food, so additional burdens should not be placed. Instead, the child can be given light rice soup, rice oil, or sugar-salt water to replenish fluids.
Edited and compiled by | Wendy
Source | Case Studies from the Jing Fang Class
Author Bio: Wendy, a Sagittarius born in the 80s, has a little girl at home, a volunteer in the Sheep Dad Intermediate Class, and a practitioner of TCM parenting. Encountered TCM in 2020 and fell in love with it.
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