Chronic Diarrhea
Overview
Chronic diarrhea is increased frequency of loose stools lasting more than two months. It may occur in IBS, inflammatory bowel disease, malabsorption, post-infectious states, lactose intolerance, or tumors. Chinese medicine holds that diarrhea is rooted in the spleen and stomach, also involving the liver and kidney, with patterns of spleen deficiency with damp excess, liver constraint with spleen deficiency, and spleen–kidney yang deficiency. Blood in stool, weight loss, nocturnal diarrhea, or fever require investigation of the cause rather than blanket "spleen tonification."
Pattern differentiation (clinical patterns)
Spleen Deficiency with Damp Excess
Intermittent loose stools worsened by greasy food, poor appetite, bloating, fatigue, sallow complexion, pale tongue white greasy coating, fine moderate pulse.
Strengthen the spleen and boost qi; transform dampness to stop diarrhea.
Liver Constraint with Spleen Deficiency
Urgent pain-triggered diarrhea relieved after defecation, induced by emotional stress, chest/rib distension, belching, poor appetite, pale red tongue thin coating, wiry pulse.
Restrain the liver and support the spleen; regulate the middle to stop diarrhea.
Spleen–Kidney Yang Deficiency
Pre-dawn periumbilical pain with borborygmi and urgent diarrhea (fifth-watch diarrhea), undigested food, cold abdomen, weak low back/knees, pale tongue white coating, deep fine pulse.
Warm and tonify spleen and kidney; astringe to stop diarrhea.
Connections
Daily care & prevention
Replace fluids to avoid dehydration, eat bland easily digested food, and track trigger foods (dairy, greasy food, caffeine, sugar alcohols); keep regular sleep, reduce stress, and care for perianal skin. Massage Zusanli (ST36), Tianshu (ST25), Zhongwan (CV12), Pishu (BL20), and Weishu (BL21). Diarrhea over 2 months, blood/black stool, nocturnal diarrhea, unexplained weight loss, fever, or new onset after age 50 warrants stool tests and colonoscopy.
When to seek medical care
Heavy blood in stool, black stool, vomiting blood, severe dehydration, fainting, persistent severe abdominal pain or fever, and diarrhea in pregnancy or infants need prompt care; rash, joint pain, or mouth ulcers warrant evaluation for inflammatory bowel disease.