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Diarrhea is characterized by frequent bowel evacuation and the passage of abnormally loose stools or liquid feces.It occurs all year round,especially in summer and autumn.Diarrhea mainly occurs in infants and young children,with the highest incidence among children aged 6 months to 2 years.Mild cases of diarrhea usually have a favorable progno-sis,while severe cases can consume body fluid and damage both qi and yin,even causing yin exhaustion and yang collapse; persistent or chronic diarrhea may also result in infantile malnutrition or chronic infantile convulsion.Diarrhea in western medicine can refer to this disease for treatment.
The causes of childhood diarrhea are mainly exogenous pathogenic factors,improper diet,and spleen-stomach weakness.The disease location mainly involves the spleen and stomach,dampness turbidity is the major pathological factor and the pathomechanism lies in spleen retention and dampness accumulation.
Children have delicate zang-fu organs,insufficient spleen qi,and can neither self-regulate cold and warm nor self-control in their diet.Incoordination between cold and warm or excessive feeding will lead to the impairment of the spleen and stomach,which may lose ascending and descending functions,fail to transform water and food,or to differentiate between purity and turbidity.The unseparated pure and turbid substances enter the large intestine together with stagnated food,resulting in diarrhea.
Since the children have unfilled infantile yang and undeveloped infantile yin,yin and yang are more vulnerable to be injured than adults after diarrhea,causing deteriorated case.Excessive diarrhea easily leads to consumption yin and qi,even deficient yin affecting yang,critical deteriorated cases will then appear.Persistent diarrhea leads to deficiency-weakness of spleen qi,and excessive liver qi generating wind,resulting in a chronic infantile convulsion; malnutrition is caused by generation and transformation absence,insufficiency of qi and blood,and dystrophy of zang-fu organs.
a.History A history of improper feeding,unhygienic diet,or attack by external pathogens.
b.Clinical manifestations The frequency and amount of stool are obviously increased;the stool is yellow,green-yellow or brown in color,watery,with undigested milk and food,loose or paste-like,or with a small amount of mucus in stool with a fetid odor.The patient may have nausea and vomiting,abdominal pain,fever,anorexia,thirst,less urine and other symptoms.For severe cases,there may be symptoms of impairment of both qi and yin,or syndrome of both yin and yang depletion,such as oliguria,high fever,excessive thirst,depressed spirits,dry skin,sunken fontanel,sunken orbits,crying without tears,red lips,deep breathing and abdominal distension.
c.Auxiliary examinations
Microscopic examination: The stool is thin and loose with fat globules or a small number of white blood cells and red blood cells.
Etiological Examination: There may be rotavirus positive,or pathogenic Escherichia coli and other bacterial culture positives.
Dysentery is characterized by acute onset,short duration,frequent stool with a small amount,mucus purulent or bloody stool,abdominal pain and obvious tenesmus.Fecal routine examination shows white blood cells =15/HPF,and red blood cells and macrophages are visible; stool culture has dysentery bacillus growth.Diarrhea is characterized by frequent stool with a large amount,watery stools without tenesmus.Fecal routine examination shows fat globules or a small number of white blood cells and red blood cells; etiological examination can detect rotavirus positive or pathogenic Escherichia coli and other positive cultures.
a.Differentiate cold and heat,deficiency and excess
It can be identified according to the case history,stool characteristics and concomitant symptoms.Cold diarrhea is marked by a history of catching a chill and drinking cold be-verages,thin or watery stools with bubbles,accompanied by abdominal pain and borborygmus; heat diarrhea is caused by summer heat-dampness or unhygienic diet,marked by frequent stool with a large amount,watery foul stool with mucus.The tongue has a yellow greasy coating.Deficiency diarrhea is marked by the weak constitution,or lingering illness,loose stools without odor or with undigested food,accompanied by poor appetite,spiritlessness or a cold body; excess diarrhea is marked by a history of dyspepsia due to improper feeding,stools sour and foul,and abdominal pain relieved after defecation.The tongue coating is white and thick.
b.Differentiate mild or severe
It can be identified according to the patient’s stools,urine,spirit,diet,and signs.Mild case is marked by stool frequency less than 10 movements a day,quite a little urine volume,fair mind,no depression in orbit,crying and tears; severe case is marked by bowel movements more than 10 times a day,watery but excessive,lack of urine,mental fatigue and drowsiness,dry skin,sunken orbit,and crying without tears.
The basic principle is to activate the spleen and transform dampness.According to different causes,excess syndromes can be applied with clearing heat and draining dampness,promoting digestion and removing stagnated-food,dispelling wind and cold; according to different consumption of zang-fu organs,deficiency symptoms can be treated through fortifying the spleen and replenishing qi,warming and reinforcing spleen-kidney,stopping diarrhea by the astringent method.Treatment of severe cases should be combined Chinese and western medicine.Besides oral administration, tuina and plastering therapy can also be applied.
Regular Syndrome
◆ Diarrhea due to Food Damage
Signs and Symptoms: increased stool frequency,stools with milk with curds and food residue with a sour rotten egg odor,abdominal pain with the desire for defecation which is relieved after diarrhea,epigastric and abdominal distention,eructation with a sour putrid odor,repeatedly flatus with foul odor,poor appetite or refusal to food,restlessness at night; thick greasy or yellow coating,slippery and rapid pulse,and purple and sluggish venules.
Essentials: a history of internal food damage,stools with a sour rotten egg odor,abdominal pain with the desire for defecation which is relieved after diarrhea.
Treatment Principles: Disperse food and transform stagnation,activate the spleen and harmonize the stomach.
Formula: Modified Băo Hé Wán (Harmony-Preserving Pill,保和丸) from Teachings of[Zhu] Dan-xi ( Dān Xī Xīn Fă ,丹溪心法).
Categorized Formula: Modified Xiāo Rǔ Wán (Milk Indigestion Eliminating Pill,消乳丸)from Standards for Diagnosis and Treatment( Zhèng Zhì Zhǔn Shéng ,证治准绳).
For children with retention of food and drink as the main symptom,apply Băo Hé Wán ; for those with retention of milk and food,apply Xiāo Rǔ Wán .
Medicinals: liù shén qū (Massa Medicata Fermentata), shān zhā (Fructus Crataegi), jiāo mài yá (Fructus Hordei Germinatus Praeparatus), lái fú zǐ (Semen Raphani), bàn xià (Rhizoma Pinelliae), fú líng (Poria), chén pí (Pericarpium Citri Reticulatae), lián qiáo (Fructus Forsythiae),and jī nèi jīn (Endothelium Corneum Gigeriae Galli).
Modifications: For vomiting,add zhú rú (Caulis Bambusae in Taenia),and shā rén (Fructus Amomi); for watery stool,add cāng zhú (Rhizoma Atractylodis) and chē qián zǐ (Semen Plantaginis); for difficult defecation,add hòu pò (Cortex Magnoliae Officinalis) and zhǐ qiào (Fructus Aurantii); for abdominal pain,add bái sháo (Radix Paeoniae Alba) and mù xiāng (Radix Aucklandiae).
◆ Diarrhea due to Wind and Cold
Signs and Symptoms: thin frothy stools with a slightly foul odor and abdominal pain with borborygmus,or with an aversion to cold,fever,thin nasal discharge; reddish tongue with a white coating,floating pulse and red finger venules.
Essentials: a history of catching a chill; thin frothy stools with a slightly foul odor and abdominal pain with borborygmus.
Treatment Principles: Expel wind and remove cold,eliminate dampness and regulate the middle jiao .
Formula: Modified Huò Xiāng Zhèng Qì Săn (Agastache Qi-Correcting Powder,藿香正气散)from Beneficial Formulas from the Taiping Imperial Pharmacy ( Tài Píng Huì Mín Hé Jì Jú Fāng ,太平惠民和剂局方).
Categorized Formula: Modified Bù Huàn Jīn Zhèng Qì Săn (Priceless Qi-Correcting Powder,不换金正气散) from Beneficial Formulas from the Taiping Imperial Pharmacy ( Tài Píng Huì Mín Hé Jì Jú Fāng ,太平惠民和剂局方).
For exuberant exterior cold,use Huò Xiāng Zhèng Qì Săn ; for exuberant dampness turbidity,use Bù Huàn Jīn Zhèng Qì Săn .
Medicinals: huò xiāng (Herba Agastachis), gé gēn (Radix Puerariae lobatae), zǐ sū yè (Folium Perillae), bái zhǐ (Radix Angelicae Dahuricae), bàn xià (Rhizoma Pinelliae), chén pí (Pericarpium Citri Reticulatae), fú líng (Poria), cāng zhú (Rhizoma Atractylodis), hòu pò (Cortex Magnoliae Officinalis), dà fù pí (Pericarpium Arecae), gān căo (Radix et Rhizoma Glycyrrhizae).
Modifications: For abdominal distention,add mù xiāng (Radix Aucklandiae) and zhǐ qiào (Fructus Aurantii); for abdominal pain,add bái sháo (Radix Paeoniae Alba) and yán hú suǒ (Rhizoma Corydalis); for poor appetite,add liù shén qū (Massa Medicata Fermentata)and shān zhā (Fructus Crataegi); for oliguria,add chē qián zǐ (Semen Plantaginis) and zé xiè (Rhizoma Alismatis).
◆ Diarrhea due to Damp-Heat
Signs and Symptoms: urgent and frequent bowel movements with profuse,watery stools and a fetid odor,or with little mucus,red anus,paroxysmal abdominal pain,nausea,vomiting,fever,excessive thirst,yellow and scantly urine; red tongue with a yellow greasy coating,slippery pulse and rapid,and purple finger venules.
Essentials: a history of external-contraction summer heat dampness or unhygienic diet;urgent and frequent bowel movements with profuse,watery stools and a fetid odor; red tongue with a yellow greasy coating.
Treatment Principles: Clear intestines and relieve the heat,resolve dampness and check diarrhea.
Formula: Gé Gēn Qín Lián Tāng (Pueraria,Scutellaria,and Coptis Decoction,葛根芩连汤)from On Cold Damage ( Shāng Hán Lùn ,伤寒论).
Medicinals: gé gēn (Radix Puerariae lobatae), huáng qín (Radix Scutellariae), huáng lián (Rhizoma Coptidis), mă chǐ xiàn (Herba Portulacae), dì jǐn căo (Herba Euphorbiae Humifusae), bái sháo (Radix Paeoniae Alba), gān căo (Radix et Rhizoma Glycyrrhizae).
Modifications: For heat predominating over dampness,add bái tóu wēng (Radix Pulsatillae) and lián qiáo (Fructus Forsythiae); for dampness predominating over heat,add yì yǐ rén (Semen Coicis) and chē qián zǐ (Semen Plantaginis); for abdominal distention,add hòu pò (Cortex Magnoliae Officinalis) and mù xiāng (Radix Aucklandiae); for vomiting,add huò xiāng (Herba Agastachis) and bàn xià (Rhizoma Pinelliae).
◆ Diarrhea due to Spleen Deficiency
Signs and Symptoms: loose stools without a fetid odor,susceptibility to postprandial diarrhea,an intermittent onset of a mild or serious condition,recurrent attacks,poor appetite,a sallow complexion,emaciation and listlessness; a pale tongue with a white coating,weak and thready pulse,and pale finger venules.
Essentials: recurrent attacks,susceptibility to postprandial diarrhea,a sallow complexion,emaciation,and listlessness.
Treatment Principles: Fortify the spleen to boost qi,promote splenic transportation and transformation to check diarrhea.
Formula: Modified Qī Wèi Bái Zhú Săn (Seven-Ingredient Atractylodes Powder,七味白术散) from Key to Diagnosis and Treatment of Children’s Diseases ( Xiăo Ér Yào Zhèng Zhí Jué ,小儿药证直诀).
Categorized Formula: Modified Shēn Líng Bái Zhú Săn (Ginseng,Poria and Atractylodes Macrocephalae Powder,参苓白术散) from Beneficial Formulas from the Taiping Imperial Pharmacy ( Tài Píng Huì Mín Hé Jì Jú Fāng ,太平惠民和剂局方).
For cases of prolonged spleen-stomach deficiency and internal consumption of body fluid,use Qī Wèi Bái Zhú Săn ; for cases of deficiency of spleen-qi and stomach-qi accompanied with dampness,use Shēn Líng Bái Zhú Săn .
Medicinals: dăng shēn (Radix Codonopsis), fú líng (Poria), bái zhú (Rhizoma Atractylodis Macrocephalae), huò xiāng (Herba Agastachis), mù xiāng (Radix Aucklandiae), gé gēn (Radix Puerariae lobatae), shān yào (Rhizoma Dioscoreae), gān căo (Radix et Rhizoma Glycyrrhizae).
Modifications: For greasy tongue coating,add pèi lán (Herba Eupatorii) and yì yǐ rén (Semen Coicis); for poor appetite,add liù shén qū (Massa Medicata Fermentata) and mài yá (Fructus Hordei Germinatus); for abdominal distention,add mù xiāng (Radix Aucklandiae)and wū yào (Radix Linderae); for abdominal coldness and pale tongue,add páo jiāng (Rhizoma Zingiberis Praeparatum) and wèi yì zhì rén (Fructus Alpiniae Oxyphyllae Rosc).
◆ Diarrhea due to Spleen-Kidney Yang Deficiency
Signs and Symptoms: persistent chronic diarrhea with clear thin stools with undigested food or a prolapsed rectum,cold body and limbs,a pale complexion,listlessness,sleeping with the eyes slightly open; a pale tongue with a white coating,thready and deep pulse,and light-colored finger venules.
Essentials: persistent chronic diarrhea with clear thin stools with undigested food,cold body,and limbs.
Treatment Principles: Warm and supplement the spleen and kidney,astringe the intestines to check diarrhea.
Formula: Modified Fù Zǐ Lǐ Zhōng Tāng (Aconite Center-Regulating Decoction,附子理中汤) from Beneficial Formulas from the Taiping Imperial Pharmacy ( Tài Píng Huì Mín Hé Jì Jú Fāng ,太平惠民和剂局方).
Categorized Formula: Modified Sì Shén Wán (Four Spirits Pill,四神丸) from Summary of Internal Medicine ( Nèi Kē Zhāi Yào ,内科摘要); Zhēn Rén Yăng Zàng Tāng (Enlightened Master Viscera-Nourishing Decoction,真人养脏汤)from Beneficial Formulas from the Taiping Imperial Pharmacy ( Tài Píng Huì Mín Hé Jì Jú Fāng ,太平惠民和剂局方).
For cases of predominant spleen-yang deficiency,and diarrhea due to abdominal coldness and pain,use Fù Zǐ Lǐ Zhōng Tāng ; for cases of predominant kidney-yang deficiency,and diarrhea before dawn,use supplemented Sì Shén Wán ; for cases of predominant spleenyang deficiency,and chronic diarrhea with prolapse,use Zhēn Rén Yăng Zàng Tāng .
Medicinals: zhì fù zǐ (Radix Aconiti Lateralis Praeparata), rén shēn (Radix Ginseng), páo jiāng (Rhizoma Zingiberis Praeparatum), bǔ gǔ zhī (Fructus Psoraleae), ròu dòu kòu (Semen Myristicae), bái zhú (Rhizoma Atractylodis Macrocephalae), bái sháo (Radix Paeoniae Alba), shí liú pí (Pericarpium Granati), gān căo (Radix et Rhizoma Glycyrrhizae).
Modifications: For prolapse of the rectum,add huáng qí (Radix Astragali) and shēng má (Rhizoma Cimicifugae); for chronic diarrhea,add chì shí zhī (Halloysitum Rubrum) and yǔ yú liáng (Limonitum).
Deteriorated Syndrome
◆ Impairment of Both Qi and Yin
Signs and Symptoms: continuous diarrhea,listlessness,irritability,limbs weakness,thirst with a desire to drink,scanty urine or anuria,sunken orbits and fontanel,crying without tears,red dry lips,dry skin; red tongue with little or no coating,thready and rapid pulse.
Essentials: continuous diarrhea,listlessness,sunken orbits and fontanel,thirst,and scanty urine.
Treatment Principles: Fortify the spleen to boost qi,transform yin with sweet and sour flavors.
Formula: Rén Shēn Wū Méi Tāng (Ginseng and Mume Decoction,人参乌梅汤) from Systematic Differentiation of Warm Diseases ( Wēn Bìng Tiáo Biàn ,温病条辨).
Medicinals: rén shēn (Radix Ginseng), wū méi (Fructus Mume), fú líng (Poria), lián zǐ (Semen Nelumbinis), shān yào (Rhizoma Dioscoreae), bái sháo (Radix Paeoniae Alba), gān căo (Radix et Rhizoma Glycyrrhizae).
Modifications: For chronic diarrhea,add kē zǐ (Fructus Chebulae) and yǔ yú liáng (Limonitum); for thirst with a desire to drink,add tiān huā fěn (Radix Trichosanthis) and shí hú (Caulis Dendrobii).
◆ Yin Exhaustion and Yang Collapse
Signs and Symptoms: continuous diarrhea with frequent profuse stools,listlessness,apathy,a pale or gray-green complexion,cold limbs,weak crying and breath,pale tongue with a thin white coating,thready and feeble pulse indicating a potentially critical condition.
Essentials: continuous diarrhea,listlessness,scanty urine or anuria,cold limbs,a thread and feeble pulse indicating a potentially critical condition.
Treatment Principles: Nourish yin and restore yang to prevent collapse.
Formula: Modified Shēng Mài Săn (Pulse-Engendering Powder,生脉散) from Origins of Medicine ( Yī Xué Qi Yuán ,医学启源),combined with Shēn Fù Lóng Mǔ Jiù Nì Tāng (Ginseng and Aconite Decoction,参附龙牡救逆汤) from Clinical Handbook of Chinese Medicinal Formulas ( Zhōng Yī Fāng Jì Lín Chuáng Shǒu Cè ,中医方剂临床手册).
Medicinals: rén shēn (Radix Ginseng), mài dōng (Radix Ophiopogonis), wǔ wèi zǐ (Fructus Schisandrae Chinensis), fù zǐ (Radix Aconiti Lateralis Praeparata), lóng gǔ (Os Draconis), mǔ lì (Concha Ostreae), bái sháo (Radix Paeoniae Alba), bái zhú (Rhizoma Atractylodis Macrocephalae), gān căo (Radix et Rhizoma Glycyrrhizae).
Modifications: For cases of cold limbs and profuse sweat,apply intravenous infusion of Shenfu Injection.This pattern belongs to a critical condition,and treatment should combine Chinese and Western medicine.
◆ Chinese Patent Medicines
1. Huò Xiāng Zhèng Qì Shuǐ (Agastache Qi Righting Liquid,藿香正气水) for diarrhea due to wind and cold.
2. Cāng Líng Zhǐ Xiè Kǒu Fú Yè (Atractylodes Rhizome and Poria Checking Diarrhea Oral Liquid,苍苓止泻口服液) for diarrhea due to damp-heat.
3. Wèi Cháng Ᾱn Wán (Stomach-Intestine Relieving Pill,胃肠安丸) for diarrhea due to food damage.
4. Yīng Ér Jiàn Pí Săn (Children’s Spleen-Fortifying Powder,婴儿健脾散) for diarrhea due to spleen deficiency.
5. Fù Zǐ Lǐ Zhōng Wán (Aconite Center-Regulating Pill,附子理中丸) for diarrhea due to spleen-kidney yang deficiency.
◆ Plastering Therapy
1.Grind wǔ bèi zǐ (Galla Chinensis) 10 g, gān jiāng (Rhizoma Zingiberis) 10 g, wú zhū yú (Fructus Evodiae) 5 g and dīng xiāng (Flos Caryophylli) 5 g into the fine powder.Mix it with distillate spirit before plastering on RN 8 ( shén què ),fixed with gauze.This therapy is applicable to diarrhea due to deficiency and cold.
2.Grind one portion of dīng xiāng (Flos Caryophylli) and two portions of ròu guì (Cortex Cinnamomi) into the fine powder.Mix ginger juice with 1–2 g powder and make a paste.Spread the paste on RN 8 ( shén què ),and fixed it with adhesive tape.This therapy is applicable to diarrhea due to windcold,or spleen-deficiency or spleen-kidney yang deficiency.
◆ Tuina
1.Diarrhea due to Food Damage: Knead băn mén and nèi bā guà ,supplement pí jīng ,clear dà cháng ,knead RN 12 ( zhōng wăn ),rub abdomen,knead ST 25 ( tiān shū ),and knead guī wěi .
2.Diarrhea due to Wind-Cold: Supplement pí jīng ,push upwards along sān guān (three passes),supplement dà cháng ,knead wài láo (EX-UE 8),knead the navel,push upwards along qī jié gǔ ,knead guī wěi ,and press and knead ST 36 ( zú sān lǐ ).For borborygmus and abdominal pain,additionally,knead yī wō fēng and grasp dù jiăo ; for a weak constitution,pinch the spine; for fright and restlessness,pinch and knead wǔ zhǐ jié ,clear gān jīng ,and open tiān mén .
3.Diarrhea due to damp-heat: Clear pí jīng ,supplement dà cháng and xiăo cháng ,push on liù fǔ ,knead ST 25 ( tiān shū ),and push along qī jié gǔ and knead guī wěi .
4.Diarrhea due to spleen deficiency: supplement pí jīng and dà cháng ,push along sān guān ,rub the abdomen,knead the navel,push along qī jié gǔ and knead guī wěi ,and pinch the spine.For cases of chronic diarrhea,additionally,knead DU 20 ( băi huì );for abdominal distention,knead nèi bā guà ;for kidney-yang deficiency,supplement shèn jīng and wài láo (EX-UE 8).
◆ Acupuncture and Moxibustion
Diarrhea due to wind-cold,kidney deficiency or spleen-kidney yang deficiency can be treated with acupuncture or moxibustion for strengthening the spleen and tonifying the kidney,warming and resolving cold dampness,or both for treating deficiency with tonification and excess with purgation;diarrhea due to food damage or damp-heat can be treated with acupuncture only for promoting qi and resolving stagnation,unblocking and regulating the zang-fu qi,with purgation as the main method.
Main Points: RN 8 ( shén què ),ST 25 ( tiān shū ),BL 25 ( dà cháng shù ),ST 37 ( shàng jù xū ),SP 6 ( sān yīn jiāo ).
Point Combination: For wind-cold diarrhea,add BL 20 (pí shù ) and SP 9 ( yīn líng quán ); for damp-heat diarrhea,add LI 4 ( hé gǔ ) and ST 39( xià jù xū ); for food-damage diarrhea,add RN 12 ( zhōng wăn ) and RN 11 ( jiàn lǐ ); for spleen-deficiency diarrhea,add BL 20 ( pí shù )and ST 36 ( zú sān lǐ ); for spleen-kidney yang-deficiency diarrhea,add BL 23 ( shèn shù ),DU 4( mìng mén ) and RN 4 ( guān yuán ).
Manipulation: All the points are needled with the routine method; salt-separated moxibustion or ginger-separated moxibustion is applied to RN 8 ( shén què ); for spleen-kidney yang-deficiency diarrhea,apply aconite cake-separated moxibustion.Acute diarrhea is treated once or twice a day while chronic diarrhea once a day or every other day.
1.Advocate breastfeeding,add supplementary food in moderation,reasonably feeding,avoid fed-upness,and avoid indigestive food.
2.Strengthen the health management of infants and young children,wash hands before and after meals,and disinfect the bottles and tableware.
3.Pay attention to food hygiene,do not eat deteriorated food,and wash the fruits before eating.
4.Control the diet,and appropriately reduce the breast milk.Fasting is recommended for patients with frequent vomiting.When the condition improves,gradually increase food intake.Pay attention to diet adjustment after recovery,and avoid greasy,cold,spicy and undigested food.
5.Pay attention to the changes of stool frequency and character,pay attention to the changes in urine volume,skin elasticity,and mental state and so on,and prevent dehydration.
6.Keep the skin dry and clean with frequent changing of diapers.After each stool,movement wash the buttocks with warm water,and powder with pine pollen powder to prevent diaper rash.
7.Take rice electrolyte solution for prevention or treatment of mild to moderate dehydration.Preparation method: rice 500 mL (5%concentration) plus salt 1.75 g.
WANG,male,age 13 months.Initial visit: Dec.5th,2004.
The patient developed fever the day before and the body temperature fluctuated from 38 to 39 degrees Celsius,coughing occasionally.From the morning,vomiting occurred 2 times,and the vomitus was the content of stomach.The stools were watery,7 times.At the time of diagnosis,the children had the fever,no cough,watery stools,and oliguria.Physical examination: the temperature of 38.3 degrees Celsius,worse spiritual reaction,pharyngeal hyperemia,no obvious abnormality of heart and lung,elastic skin,red tongue with a thin yellow coating.Routine blood test: white blood cell count 9.8 × 10 9 /L,neutrophil 48%,lymphocyte 44%.Stool test: dilute water stool,white blood cell 0–1/HP.Urine test: urine ketone (+ + +).Rotavirus test: positive.It was diagnosed with damp-cold-type diarrhea.
Therapeutic method: Clear heat and drain dampness.
Prescription: gé gēn (Radix Puerariae lobatae) 5 g, chuān huáng lián (Rhizoma Coptidis)1.5 g, mù xiāng (Radix Aucklandiae) 3 g, qīng bàn xià (Rhizoma Pinelliae Concisum) 5 g, gān căo (Radix et Rhizoma Glycyrrhizae) 3 g, zé xiè (Rhizoma Alismatis) 5 g.2 doses,decocting 100 mL,taken separately,and correcting water-electrolyte balance by infusing electrolyte solution.
Dec.7th: The patient had a fever yesterday without vomiting,diarrhea,abdominal distension,watery stools 6–8 times a day,no mucus stool,and increased urine volume.The tongue is red with a thin and white coating.Method of strengthening the spleen to check diarrhea was recommended in Chinese medicine.
Prescription: huò xiāng (Herba Agastachis) 5 g, gé gēn (Radix Puerariae lobatae) 5 g, mù xiāng (Radix Aucklandiae) 3 g, dăng shēn (Radix Codonopsis) 5 g, bái zhú (Rhizoma Atractylodis Macrocephalae) 5 g, fú líng (Poria) 5 g, gān căo (Radix et Rhizoma Glycyrrhizae) 3 g, chuān huáng lián (Rhizoma Coptidis) 1 g.After 2 doses administration,the patient’s stools became normal,appetite increased,and he became lively.The tongue was reddish with a thin white coating.After recovery,the patient was given Băo Hé Săn (Harmony-Preserving Powder) to recuperate the spleen and stomach.
Analysis: Autumn diarrhea is more common in pediatrics.Initially,it is caused by external contraction involving both exterior and interior,manifested as pyretic dysentery in On Cold Damage ( Shāng Hán Lùn ,伤寒论) , and can be treated with Gé Gēn Qín Lián Tāng (Pueraria,Scutellaria,and Coptis Decoction,葛根芩连汤) for releasing exterior,clearing heat and draining dampness.Children’s spleen is often insufficient.There will be dysfunction of transportation and transformation after the fever is brought down or the exogenous pathogens are resolved,which should be treated with Qī Wèi Bái Zhú Săn (Seven-Ingredient Atractylodes Powder,七味白术散)for strengthening the spleen to stop diarrhea.If there is obvious diarrhea or fever, chuān huáng lián (Rhizoma Coptidis),bitter and cold,can be used to strengthen the intestine to stop diarrhea. zé xiè (Rhizoma Alismatis) in the prescription is to promote diuresis and harden the stool.
Source: Ma Rong. Li Shaochuan’s pediatric experience collection .People’s Medical Publishing House,2013: 130.