TRADITIONAL INTERNAL MEDICINE – DISEASES & FORMULAS

Diarrhea & Dysentery

Flux (Diarrhea)
Bloody Flux (Dysentery, or Diarrhea with Blood)

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Neue Artznei und Practicierbuchlin, Bock, 1551

Diarrhea is a large problem is the developing world. It is the second leading cause of death in children with over 500,000 children under the age of 5 dying annually according to WHO figures. It is also the leading cause of malnutrition in children. It is both preventable and treatable.

Acute Diarrhea is most commonly caused by an intestinal infection, either bacterial, viral or parasitical.

Types of Diarrhea in Traditional Medicine:

Diarrhea: passage of fluid from the bowels without Blood or Food
Dysentery (Bloody Flux): Diarrhea with Blood and Mucus
Lientery, Lienteria, or Coeliac Passion: passage of undigested food in the Stool. Due to severe deficiency (Yang deficiency) and weakness of the retentive faculty
Coeliac Passion: Diarrhea with partly digested food, due to the Stomach not retaining the food

According to Humor:

Choleric (Bile/Heat): burning Diarrhea, inflammation, foul smell, with Fever in acutes cases
Phlegm: passage of Phlegm, excess clear Urine, pale face, thick tongue coat
Melancholy: dark or black Diarrhea, distention or heaviness over the Spleen, a melancholic constitution
Serous or Watery: copious water passed through the bowel, perhaps with edema, wet tongue

According to Energetics:

Heat–type Diarrhea

Typically associated with Infection and/or inflammation such as Gastroenteritis. It may be the result of Food or Water poisoning and often comes with Fever, abdominal pain, and burning, foul-smelling, loose, watery stool. Because it is associated with Fever, Inflammation and Infection, it is classed as a Heat disease. Because the Fluids are also involved, it is classed as Damp-Heat in TCM. Treatment uses bitter and dry medicines to clear Damp-Heat and stop Diarrhea.

Cold–type Diarrhea

Associated with internal Coldness and Damp. In Western Tradition it might be referred to Coldness in the Stomach and Intestines. In TCM, it may be associated with Cold and Damp attacking the Stomach and Intestines, or in severe cases, Spleen and Kidney Yang deficiency. The stool is loose and watery, but without burning or foul smell. There may be undigested food in the stool (due to lack of Heat). Treatment uses Warm and dry Stomachic medicines to increase digestion, stimulate digestive fire (Agni or Spleen Yang), as well as drying astringent medicines to restrain excess fluid.

Chronic Diarrhea

Chronic cases are usually associated with deficiency. Even if the initial disease was excess Heat, it will eventually drain the body and cause deficiency. Chronic cases can be from Cold and deficiency of the Spleen and/or Kidneys. Cases with excess Phlegm/Damp require drying medicines along with medicines to strengthen the Spleen. In chronic cases with Heat, cold medicines may be prescribed with suitable tonics.

Diarrhea with Blood

Diarrhea with Blood may occur in prolonged Damp-Heat type infective Diarrhea, or in serious infections such as Amoebic Dysentery. In these cases, medicines to clear Heat and combined with demulcents to sooth the membranes and with drying medicines that stop Bleeding, for example Red Earth.

Dysentery

Dysentery is treated similarly to Diarrhea, along certain medicine have shown particular efficacy against Dysentery. Acute Dysentery is usually Damp-Heat. In chronic cases, the patient becomes weak and requires astringent and strengthening medicines. Dysentery is often divided into “Red” and “White”, that is, Dysentery with Blood or Pus respectively. If there is Blood present in the stool, medicines to stop bleeding are combined with astringents. If there is pus, medicines that clear heat and toxin are combined.

Ayurvedic Differentiation of Dysentery:

1. Vata (Wind) Dysentery: acute pain, rumbling, bloating, with lassitude
2. Pitta (Bile) Dysentery: foul smelling stool with blood, urning sensation, fever
3. Kapha (Phlegm) Dysentery: Mucus in the stool which is loose, cold feeling

Dysentery is a particularly dangerous disease, especially in developing countries where it is still responsible for many fatalities.

Important Notes

1. As always, treat the underlying condition. Hot medicines will be beneficial to Diarrhea from Cold and Damp, whereas the same medicines may aggravate Hot-type Diarrhea.
2. In the treatment of Diarrhea and Dysentery, it is important to separate acute and chronic cases. Acute heat or damp-heat cases are generally associated with an acute bacterial or viral infection and require bitter, draining medicines to attack the pathogen. Chronic cases require astringent and strengthening medicines. If cold, draining medicines are used in chronic cases with weakness, it will drain them further. If astringent tonic medicines are used in acute cases with Heat, the pathogen may be strengthened or penetrate deeper.

Some Herbs with Proven Anti-amoebic Activity:

Pomegranate rind
Garlic
Long Pepper
Nutmeg

Bael (Agele) fruit
Cotton seed
Plantain seed
Galls

Wormwood
Cyperus rontundus
Holarrhena
Barberry

Coptis Huang Lian
Scutellaria Huang Qin
Pulsatilla Bai Tou
Chebula


Western Tradition

Simples

Tormentil
Agrimony
Pomegranate flower
Galls
Rosehip
Chebula (scorched)
Red Earth
Alum

Bistort
Camomile
Pomegranate rind
Sumac
Nutmeg
Rhubarb (scorched)
Kaolin
Burnt Deer horn

1. “Many give Parched or Torrefied Rhubarb”; which has been highly praised for Diarrhea and Dysentery when used as a single medicine.
The French infused Rhubarb twice, then washed in 3 times in Rose water, then dried it. This makes it milder, more pleasant, and better to astringent.
Lusitanus takes the second Infusion of Rhubarb, and says, That in the first infusion all the sharpness is taken away, and it is better so than parched”.
2. Likewise, Scorched Chebulic or Yellow Myrobalan has been used as a stand-alone medicine.
3. “The decoction of Juniper Bernes in wine given three days together is good; and also one dram of the Powder of Grasshoppers given in white Wine. These two help by deriving the Matter of the flux to the Ureters”. (The Practice of Physick, 1663)

TCM Classification

Simples

Pulsatilla Bai Tou Weng
Agrimony (Xian He Cao)
Galls (Wu Bei Zi)
Coptis Huang Lian
Rosehip (Jin Ying Zi)
Nutmeg (Rou Dou Kou)
Schisandra Wu Wei Zi
Limonite (Yu Yu Liang)
Red Earth (Chi Shi Zhi)

Phellodendron Huang Bai
Plantain seed (Che Qian Zi)
Chebula (He Zi)
Scutellaria Huang Qin
Lotus seed (Lian Zi)
Pomegranate rind
Prunus mume (Wu Mei)
Alum (Bai Fan)
Oven Earth (Zao Xin Tu)


Diarrhea

General for Diarrhea and Dysentery

Syrup of Chebulic Myrobalan
Syrup of Quince with Spices (Nicholas)
Syrup of Dry Rose
Conserve of Pomegranate flower
Quince Conserve
Micleta (Nicholas)
Athanasia Greater (Nicholas)
Triphera Minor (Triphera Phoenonis) (Mesue)
Powder for Dysentery (Nicholas)
Powder for Dysentery (Riverius)
Powder for Dysentery of Galen
Troches of Sealed Earth
Troches of Ramich (Mesue)
Pills Against Fluxes (Nicolas)
Bilwadi Churna (Ayurveda)

Diarrhea, Chronic

1. “Pills of Bdellium taken twice or thrice in a week, or every other day, are good against all old Fluxes [Diarrheas]” (The Practice of Physick, 1663)
2. Mastic taken with Sealed Earth (or Red Earth) if there is weakness in chronic diarrhea.

Electuary of Scoria Ferri
Athanasia Magna
Syrup of Chebulic Myrobalan
Syrup of Myrtle Simple
Syrup of Myrtle Compound
Coptis 5 Pill (Tibetan Medicine)

Diarrhea, Bilious (from Bile Humor)

To Purge Bile while astringing, use Rhubarb (1 dram), Yellow Myrobalan (½ dram); infuse in Plantain water, strain and add Syrup of Roses (1 ounce).
1. Plantain boiled in broth is excellent.
2. Conserve of Rosehips
3. Syrup of Coral was commended
4. Enemas of the Cold Seeds, Poppy seed and other emollients if there is extreme heat and inflammation.

Syrup of Chebulic Myrobalan
Syrup de Agresta
Rob of Currant
Rob of Barberry
Troches of Ramich (Mesue)
Troches of Spodium (Avicenna)
Coptis 5 Pill (Tibetan Medicine)
Crystal Moon 37 (Zla shel so bdun) (Tibetan Medicine)

Diarrhea, Pituitous (from Phlegm Humor)

Syrup of Mint
Triphera Minor (Triphera Phoenonis) (Mesue)
Bilwadi Churna (Ayurveda)

Acute Cold Damp

acute diarrhea, cramping abdominal, epigastric and abdominal distension, loss of appetite, nausea, lethargy.
Huo Xiang Zheng Qi Shui

Acute Damp Heat

acute or recurrent diarrhea, burning and smells badly, maybe violent diarrhea, fever, restless, cramping abdominal pain, high colored urine, thirst.
Ge Gen Huang Qin Huang Lian Tang

Liver Qi Invading the Spleen

recurrent diarrhea, stomach pain after diarrhea, abdominal distension, poor appetite, nausea, indigestion, flatulence, irritability.
Bai Zhu Shao Yao San
Tong Xie Yao Fang

Stomach and Intestine Cold / Damp

diarrhea and loose stool, abdominal pain relieved by warmth, pale tongue with white coat, slow pulse.
Gan Cao Gan Jiang Fu Ling Bai Zhu Tang
Li Zhong Wan
Tao Hua Tang

Spleen and Stomach Deficiency

frequent loose stools or diarrhea, abdominal distension, poor appetite, fatigue, sallow complexion, puffiness around the eyes, weight loss.
Bu Zhong Yi Qi Tang
Xiang Sha Liu Jun Zi Tang
Li Zhong Wan
Ling Gui Zhu Gan Tang
Shen Ling Bai Zhu San

Yang Deficiency

diarrhea, especially early in the morning, cold and pain of the abdomen, fear of cold, cold feet, lower back pain, weak knees, poor digestion, poor appetite, fatigue, always tired.
Ling Gui Zhu Gan Tang
Fu Zi Li Zhong Wan
Si Shen Wan
Wen Pi Tang

Food Stagnation

acute diarrhea or chronic intermittent diarrhea, foul smelling stools, abdominal distension and pain, bad breath, acid reflux, nausea, foul smelling flatulence.
Bao He Wan
Jian Pi Wan


Special Formula

1. “To eat in his Bloody Flux every morning fasting half a dram of Rhubarb parched [scorched], is a thing well tried, and very acceptable”.

POWDER TO STOP DIARRHEA (HUZ)

    Cumin, vinegar prepared
    Caraway, vinegar prepared
    Pomegranate flower
    Myrtle seed
    Gum Arabic
    Bengal quince
    Bdellium
    Carob
    Dried, roasted coriander.           equal parts
Powder. Make a potion with 10–15 grams of it. Henbane seed can be added. (Rhazes)

RESTRAINING POWDER TO STOP DIARRHEA (RHAZES)

    Roasted pomegranate rinds
    Sumac
    Roasted starch
    Red (Armenian) Earth               5 dirhams ea.
    Gum arabic
    Tragacanth
    Purslane seed toasted
    Red Coral, prepared
    Burnt Deer horn                         3 dirhams ea.
Powder finely. Used for Diarrhea and loose bowels.. The dose is 2 dirhams taken with quince syrup. (Continens)

POWDER FOR DIARRHEA.

    Dragons Blood
    Frankincense
    Mastich
    Terra Sigillata
    Hematite
    Troches of Amber                      1 dram ea.
    Armenian (Red) Earth                3 drams
Powder. Take 2 drams in convenient Liquor, such as Plantain water.

1.  Plantain seed (Che Qian Zi) 10 grams
    Black Tea                                3 grams
Boil briefly, then steep. Used for Spleen deficient Diarrhea or Diarrhea from Heat or Heat and Damp.
2. Hawthorn fruit, stir-fried     25 grams
    Costus                                     6 grams
    Black Tea                               15 grams
Decoct and add Sugar (White Sugar for Heat and Blood; Brown Sugar for Spleen deficiency)

STOP DIARRHEA TEA (Zhi Xie Cha)

    Honeysuckle (Jin Yin Hua
    Green tea                               9 grams ea.
    Rose
    Tangerine peel (Chen Pi)     6 grams ea.
    Jasmine flower
    Licorice                                   3 grams ea.
This is prepared as an infusion.

TWO FLOWER TEA (Er Hua Cha)

    Black tea   
    Honeysuckle (Jin Yin Hua)  9 grams ea.
    Rose 
    Licorice
    Coptis Huang Lian                6 grams ea.


Dysentery

Crato said Astringents should not be given before the 7th day, after that, gentle astringents should be used. Astringents are generally only used once Heat and inflammation has been settled.

“Veal broth boiled very long doth assuages pain in the Ulcers”.
Cream of Rice heals Ulcers; or Cream of Barley with Sugar; Rice boiled in Almond Milk
“The Juice of Quinces boiled to the consistency of a Syrup or Rob, without an addition, given a spoonful or two often, is very profitable”.

Dysentery

1. Juice of Plantain given, three or four ounces at a time.
2. “Hollerius says, That the Juice of Ground-Ivy taken, has saved many a mans life”.
3. As with Diarrhea, Rhubarb taken, either after parching or raw, is very profitable. (see above0
4. “A Quince made hollow and filled wich the shavings of Virgin Wax, roasted under the Embers, given for some few days together, is a most proper Remedy”. (The Practice of Physick, 1663)
5. “In the end of a Dysentery the Juice of Wormwood and Mints well purified, and made into a Syrup with Sugar, is very available: For Mints mixed with Wormwood has great force to strengthen the Stomach”. (The Practice of Physick, 1663)

Syrup of Marshmallow (Fernel)
Powder of Chebula and Rhubarb (Philon)
Powder of Tormentil Compound (Grieves)
Powder for Dysentery (Nicholas)
Powder for Dysentery (Rhazes)
Powder for Dysentery (Riverius)
Powder for Dysentery of Galen
Philonium Persicum (if there is great pain)
Electuary of Micleta (Nicholas)
Troches of Coral (Diacorallium) (Nicholas)
Bilwadi Churna (Ayurveda)

Diarrhea or Dysentery with Blood

1. Rhubarb (1 oz.), burnt Deer Horn (2 drams). Powder and form 3 boluses with Conserve of Roses.
2. Plantain juice with Barley water.
3. Comfrey, burnt Rhubarb, Chebula
4. Comfrey, Knotgrass, Shepherd’s Purse, Cinquefoil, Plantain, Ribwort Plantain, Strawberry leaves (1 handful each), decoct.
5. Woman’s Milk taken for 9 days together was said to cure any Bloody Flux

Athanasia Greater (Nicholas)
Powder for Dysentery (Rhazes)
Troches of Coral (Galen)

Damp Heat

frequent foul-smelling diarrhea with blood and mucus, burning feeling when defecating, abdominal pain, scanty urine, red eyes, fever, restless, dry mouth.
Bai Tou Weng Tang
Ge Gen Huang Qin Huang Lian Tang
Huang Qin Tang
Shao Yao Tang
Lian Po Yin

Epidemic Heat and Toxin

explosive diarrhea with blood, high fever, severe abdominal pain, thirst, dehydration, headache, nausea, vomiting, irritable; in severe cases delirium, convulsion, severe cramping, cold limbs.
Huang Qin Tang
Huang Lian Jie Du Tang
Bai Tou Weng Tang
Zhi Bao Dan

Liver Qi Invading the Spleen

chronic or recurrent diarrhea with blood or mucus, abdominal distension, irritable, depression, headache, red eyes, red face, night sweats, hot feeling, bitter taste, dry mouth.
Dan Zhi Xiao Yao San

Spleen Qi Deficiency

chronic diarrhea with blood and mucus, fatigue, poor appetite, indigestion, weak pulse
Bu Zhong Yi Qi Tang
Jian Pi Wan

Yang Deficiency

chronic dysentery, diarrhea is worse in the cold or after cold food, mild tenesmus, abdominal pain, feels cold, poor appetite, fatigue, pale complexion, cold extremities, lower back and legs pain and weak, deep, slow and weak pulse
Fu Zi Li Zhong Wan
Zhen Ren Yang Zang Tang
Si Ni Tang
Si Ni Jia Ren Shen Tang
Si Shen Wan

Yin Deficiency

chronic diarrhea with little mucus and blood, mild lower abdominal pain, tenesmus, nausea, poor appetite, dry mouth, tidal fever, night sweats, emaciation.
Huang Lian E Jiao Tang

Food Stagnation

diarrhea, foul smelling stools, abdominal distension and pain, bad breath, acid reflux, nausea, foul smelling flatulence.
Mu Xiang Bing Lang Wan


Special Formulas for Dysentery

PURGATIVES FOR DYSENTERY
At first, the body is to be purged, if strength allows:
i. Plantain                                  ½ handful
    Licorice, Raisins                    3 drams ea.
    Roses                                      1 pugil
    Tamarind                                6 drams
    Yellow Myrobalan, rubbed
      with Almond oil                  2 drams
Boil to 3 ounces, To the strained decoction infuse Rhubarb 1 dram
ii. Tamarind                                ½ oz.
    Yellow Myrobalan                2 drams
Decoct in Barley water, in the strained infusion add Rhubarb 1 ½ drams.
iii. Chebulic Myrobalan            10 drams
    Yellow Myrobalan                5 drams
    Currants                                 2 oz.
Boil in 26 pints of water until one-third has wasted. Add Sugar to taste, and infuse in Cinnamon ½ oz.

POWDERS FOR DYSENTERY:
(To be used after necessary purging)
i.  Bistort, Tormentil                   1 dram ea.
    Red Coral, Pearl                    ½ dram ea.
Powder and take 1 dram in broth.
It may be strengthened and made more stringent by adding Pomegranate flowers, Galls and Red Earth.
ii. Tragacanth                             1 dram
    Nutmeg, Coral prepared    ½ dram ea. 
Powder and divide into 3 doses to be taken with broth.
iii. Burnt Deer horn
    Armenian (Red) Earth
    Red & White Coral
    Three Sandalwoods
    Mastic                                    ½ dram ea.
    Frankincense
    Tragacanth                            ½ scruple ea.
Powder; take ½ dram often.
iv. “Hercules Saxonia says, That all new Dysenteries are presently, and surely Cured by this Powder”:
    Cuttle-bone burnt                2 drams
    Sponge dipped in Pitch
      and burnt in a pot
    Egg shells (membranes
      removed)                              1 dram ea.
Powder. Dose is 1 dram.

A PROVEN FORMULA FOR DYSENTERY

    Yellow Myrobalans, parched
    Plantain seed, parched
    Sorrel seed, parched
    Endive seed, parched          3 drams ea.
    Cordial flowers (except
      Violet)                                    1 handful ea.
Boil gently in water in which Steel has been quenched a number of times. Strain and add Rhubarb, parched, 2 ½ drams and Philonium Persicum, 4 scruples.
“This drink is found very good by experience” (Secrets of Alexis)

ANOTHER FOR DYSENTERY:

    Frankincense
    Mastic
    Red Earth
    Red Coral 
    Burnt Deer Horn                    ½ dram ea.    
    Hematite burned                   2 scruples
Powder, steep in dry red wine. Give 1 ½ drams before bed. (Secrets of Alexis)

ENEMA FOR DYSENTERY TO HEAL THE ULCERS
    Comfrey root
    Mullein root                            1 oz. ea.
    Plantain
    Yarrow                                     1 handful ea.
    Rose
    Parched Barley                      1 pugil ea.
Decoct; add Honey of Roses and mucilage of Tragacanth, 1 oz. each.
    

1. Decoct Green tea (2 grams) in 100 mls of water down to half.
2. Agrimony and aged Black tea, equal parts, decocted.
3. Prunus mume (Wu Mei) 1 piece, Black Tea, decoct
4. Prunus mume (Wu Mei), fresh Ginger, decoct
5. Chinese Red Dates (Da Zao), Green tea, decoct and add Honey

ANCESTRAL POPPY AND MUME DECOCTION
(Zu Chuan Ying Mei Tang)

    Poppy capsules (Ying Su Ke)     15 grams
    Licorice                                           9 grams
    Prunus mume (Wu Mei)               7 pieces
    Black Pepper                                 7 pieces
    Black tea                                         9 grams
Decoct all the ingredients twice, combine the strained liquids, add Brown Sugar. This is only used for chronic and persistent cases of dysentery. It is not for acute Heat-type dysentery.

An Ayurvedic Compound

    Barberry
    Chebula
    Boerhaavia
    Tinospora
    Ginger
Powder or Decoction (Ayurveda)


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