A 31-year-old woman with a two-year history of emotion-triggered chronic diarrhea and abdominal pain was managed using a comprehensive strategy to strengthen the Spleen and astringe the intestines.

Case ID: CHC-0013

Case Summary

This case describes a 31-year-old woman who presented with a two-year history of chronic diarrhea and abdominal pain, conventionally diagnosed as Irritable Bowel Syndrome (IBS). The original report documented a TCM assessment of Spleen and Kidney deficiency, complicated by Liver Qi stagnation. The patient was managed through a tailored herbal approach that initially combined Spleen-fortifying and intestinal-astringing herbs, which was later refined to focus on long-term digestive tonification.

Patient Presentation

• Patient: 31-year-old female.
• Main Complaint: Chronic diarrhea with yellow, loose stools 2 to 4 times a day for two years.
• History: The patient reported a two-year history of chronic diarrhea that was highly reactive to emotional fluctuations and minor dietary indiscretions. Her bowel movements were characteristically preceded by abdominal pain, which was immediately relieved after defecation. She also experienced occasional abdominal bloating. Her sleep and urination were normal. She had no history of infectious diseases, food allergies, or toxic exposure.

Examination and Diagnosis

• Conventional Diagnosis: Irritable Bowel Syndrome (IBS). A physical examination of the abdomen was unremarkable (flat, soft, no tenderness or rebound pain, negative Murphy’s and McBurney’s signs). Bowel sounds were normal (4 times/minute).
• TCM Tongue and Pulse: The tongue was pale and dark with a white, greasy coating. The pulse was stringy and fine (弦细).

TCM Assessment

The original practitioner interpreted the presentation as Diarrhea driven by Spleen and Kidney deficiency (脾肾亏虚).

According to the principles of Yin and Yang Chinese Medicine, chronic Spleen Yang deficiency (a lack of digestive fire) will eventually deplete Kidney Yang over a prolonged period. In this patient, the weakened Spleen failed to properly transport and transform fluids, leading to internal dampness (indicated by the white, greasy tongue coating). This caused clear nutrients and turbid waste to mix together and descend abnormally as diarrhea.

Furthermore, the stringy pulse and the specific symptom of “abdominal pain before diarrhea, relieved after defecation” strongly suggest the involvement of the Liver. Emotional fluctuations caused Liver Qi to stagnate and subsequently “overact” on her already weakened Spleen, serving as the acute trigger for her intestinal spasms and urgent bowel movements.

Treatment Approach

The primary treatment principle was to strengthen the Spleen, tonify the Kidneys, and astringe the intestines to stop diarrhea (健脾益肾，涩肠止泻). The strategy involved addressing both the functional weakness of the digestive organs and the physical loss of fluids.

Herbal Formulas and Modifications

• Initial Formula (February 10, 2020): The practitioner prescribed a complex formula addressing multiple mechanisms simultaneously:
  • Soothing the Liver and Stopping Spasms: Chai Hu, Bai Shao, Zhi Shi, and Zhi Gan Cao (the classic Si Ni San structure) were utilized to soothe Liver Qi, relax smooth muscle spasms, and address the pre-defecation abdominal pain.
  • Strengthening the Spleen and Resolving Dampness: Shu Dang Shen, Bai Zhu, Fu Ling, Chen Pi, and Sha Ren were included to fortify the foundational Qi of the Spleen and dry the internal dampness. Chao Mai Ya was added to aid digestion.
  • Astringing the Intestines: To rapidly control the chronic fluid loss, strong astringent herbs including Wu Mei, Jin Ying Zi, Qian Shi, and Qin Pi were strategically incorporated.
• Modification (February 17, 2020): At the second visit, after the acute diarrhea was controlled, the practitioner modified the formula by removing the heavy astringents (Jin Ying Zi and Qian Shi). The focus shifted entirely to the root cause: strengthening the Spleen and tonifying the Kidneys.

Follow-Up

• February 17, 2020 (Second Visit): After seven doses of the initial decoction, the source reported a significant reduction in the frequency of diarrhea. The pre-defecation abdominal pain was markedly alleviated, and her appetite remained stable. The formula was subsequently adjusted to consolidate these improvements.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the practitioner’s dynamic adjustment of the treatment strategy. IBS is often a complex intersection of emotional triggers and digestive weakness. The initial formula expertly bridged these aspects by combining Liver-soothing herbs to stop the pain with Spleen-fortifying herbs to resolve the dampness.

More importantly, the original report demonstrates precise clinical timing. Astringent herbs (Jin Ying Zi, Qian Shi) are highly effective for stopping diarrhea (treating the branch symptom), but they can hinder digestion if used for too long. Once the symptom frequency decreased by the second visit, the practitioner decisively removed the astringents. This reflects the core TCM reasoning of utilizing astringents only as a temporary measure to stop acute leakage, while relying on Spleen and Kidney tonification as the true, long-term solution.

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What This Case Can — and Cannot — Tell Us

This is an individual case report, not a controlled clinical trial. It documents the reasoning, treatment, and outcome reported for one patient and should not be interpreted as evidence that the same approach will produce the same result in another person.

Source

• Original source: Dongguan Hospital of Traditional Chinese Medicine (东莞市中医院) / Guangdong Provincial Administration of Traditional Chinese Medicine
• Original title: [【以案说医】董明国：健脾益肾，涩肠止泻法治疗泄泻案]
• Practitioner: Professor Dong Mingguo (董明国)
• Publication date: October 29, 2024
• Original language: Chinese
• Source link: [View original page]
• ChineseHerb.org version: English translation and editorial adaptation