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by U.S.A. Medical Doctor & Herbalist.


 Diarrhea, like any other X symptoms, is a set of regulatory responses by an organism to an imbalance of bioenergies caused by multiple pathogenetic mechanisms. Natural herbal remedies in formulas steadily treat the roots of diarrhea by tonifying the absorptive functions of colon and correcting the deranged neurohormonal circuitry and motility of gastrointestinal system.  

Pathophysiology of Diarrhea: There are two equally valid and clinically useful perspectives with different languages.


Biomedical theories ( One can skip this section, if familiar with the subject):

Why do some people suffer from chronic " diarrhea " with liquidy stools or even stools with undigested food particles, with fairly normal colonoscopies ( the probability of finding a cause for chronic diarrhea by colonoscopy is neary < 1%) ?                                                            


Diarrhea, to public, means liquidy stools with increased frequency. Its biomedical definition is stool weight > 200 grams/day.

Chronic Diarrhea is diarrhea lasting > 3 to 4 weeks. Biomedicine proposes 5 different causative mechanisms.

#1) Secretory diarrhea is abnormal fluid and electrolyte transport across mucosa of small intestine and colon, with large volume loose stools which usually persist despite fasting. Its causes are a) laxative abuse, or b) decreased funtional surfaces for absorption ( crohn's disease, resection of intestines, chloridorrhea or chloride rich watery diarrhea due to defective CL/HCO3 mucosal exchange, and hormones from tumors causing production of intestinal secretagogues ), or c) cholera. In bild acid malabsorption in terminal ileum, either the excess amount of bile acids ( overproduction of bile acids by the liver, idiopathic ) or deconjugated bile acids ( bacterial overgrowth in small intestines, postcholecystectomy ) enter the colon and cause hypersecretion of water and increased motility, and produce chronic diarrhea.

#2) Osmotic Diarrhea means that osmotically active solutes enter colon and draws fluids exceeding the resorptive capacity of colon  ( which may be 3.2 liters/day, and thus,this type of diarrhea is not severe unless the colonic transit time is very shortened usually from autonomic dysfuntion). Its causes are a) osmotic laxatives ( Magnesium), b) lactase deficiency with lactose intolerance, c) antibiotic associated diarrhea, and d) pancreatic insufficency in which undigested carbohydrates and lipids reach the colon, and become hydrolyzed by bacteria to short chain fatty acids which exceed the colon's absorptive capacity. Osmotic diarrhea is usually not severe or even hard to diagnose. Most persons suffering this do not seek alternative medicine.

#3) Fat malabsorption with greasy stools and nutritional deficiency are usually diagnosed, and most people instinctively know it when they have this condition.

#4) Inflammatory mechanisms include mucosal exudation, hypersecretion of electrolytes and fluids, and hypermotility of colon. Its most common cause is inflammatory bowel disease including ulcerative colitis, and are usually diagnosed. Others include bacterial infections such as shigellosis and intestinal lymphangiectasia.  In exudative processes there is decreased epithelial barrier function caused by inflammation of enterocytes and loss of tight junctions. Increased hydrostatic pressures in microvessels and lymphatics cause water, electrolytes, mucus, proteins, and red and white blood cells to collect intraluminally. In herbal medicine, these are represented by damp heat diarrhea, blood stasis, or/and liver Qi stagnation mostly, and often require prolonged treatments.

#5) Dysmotility of bowel with rapid transit due to visceral autonomic neuropathy ( " diabetic diarrhea" ),or disordered neurohormonal regulation of colonic and anorectal function ( " Irritable bowel syndrome", or "idiopathic chronic diarrhea" ). The latter pathophysiology is the most common, and frustrating  for the biomedical treatments which offer only the chronic usage of opioids, which have subtle and unrecognized long term ill effects on our psyche and bodily functions, including depletion of bioenergy called " Qi and Blood " in eastern herbal medicine, which culminate in slowing of all autonomic functions, chronic weakness/ fatigue, lowered immunity, etc. 

The most common identifiable causes of chronic diarrhea are hormonally active tumors, ileal disease or resection, postcholecystectomy, intestinal lymphangiectasia, advanced diabetic neuropathy with degeneration of adrenergic nerves ( uncommon, most diarrhea in diabetic patients are not due to neuropathy ), Celiac disease, pseudomembranous colitis ( caused by prolonged usage of antibiotics producing the overgrowth of clostridium difficle in colon ) and inflammatory bowel disease. The rest involve multiple mechanisms. They are called Chronic Idiopathic Diarrhea. 

Chronic Idiopathic Diarrhea is functional diarrhea where all the biomedical diseases and over usage of medications are ruled out, and are common. Biomedical treatments are usage of opiodlike drugs such as imodium and may not work. 

Clinically useful Eastern Herbal Theories:

According to eastern herbal medicine, chronic diarrhea is caused by 2 major categories of mechanisms.

#1) is acute or chronic retention of pathogenic factors in bowels which cause hypersecretory mucosa, exudative inflammatory mucosa, and disordered motility of colon.

1A), called damp heat in colon, causes foul smelling yellow diarrhea with frequency, abdomenal discomfort, and burning anus. Treated by Acute Diarrhea ( it treats also chronic diarrhea due to damp heat) . Sometimes, it takes a long time to clear chronic damp heat ( it takes a long time to mop up the muddy water in every nook and cranny in the house ). Using opiod drugs chronically is a self ruining " treatment ", because the opiods work by putting the neurons to sleep and slowing down the intestinal peristalsis, but does not do anything to eliminate the cause of inflammatory diarrhea, the toxins ( internally generated in most cases of chronic smelly diarrhea ). This type of Diarrhea is the body's attempt to rid the toxins, but the opiods will allow the toxins build up further in the colon and enter the bloodstream to subtly damage the other parts of our body. Physicians herbal formulas are natural herbal remedies for diarrhea which not only eliminate the toxins, but also gradually restore the bioenergetic imbalances that cause the build up of the toxins in the intestines in the first place.

1B) called liver Qi stagnation with some heat is treated by Irritable Bowel ( may have alternating diarrhea with constipation )   

#2) category is Qi / Yang ( "bioenergy and warming bioforce" )deficiency of spleen, stomach,or kidney. Deficiency of bioenergy is manifested by the hypofuntioning of enteric and autonomic nervous system. Submucosal nervous plexus which controls absorption and secretion of electrolytes and fluids are devoid of energy, and fail to control chloride ion channels and produce watery diarrhea. Sympathetic nervous system ( "active Qi/ Yang" )which provide inhibitory control on the smooth muscles of colon may fail and hypermotility of colon ensues.

2A) called Spleen Qi deficiency ( insufficiency of transformation and transportation of liquids in our body ) results in chronic loose or watery stools and fatigue. This type is very common. Treated by Chronic Diarrhea

2B) called Kidney and spleen Yang deficiency is a cause of diarrhea  usually in elders or someone with long term illnesses . It requires a long term management with Chronic Diarrhea