A 47-year-old man with a 10-year history of chronic diarrhea and abdominal pain was managed using a combined herbal strategy to soothe the Liver, strengthen the Spleen, and clear intestinal stasis.

Case ID: CHC-0012

Case Summary

This case describes a 47-year-old man who presented with a chronic, 10-year history of irritable bowel syndrome (IBS), characterized by abdominal pain followed immediately by urgent diarrhea. The original report documented a TCM assessment of Liver and Spleen disharmony complicated by damp-heat. The patient was managed through a multifaceted herbal approach designed to regulate the Liver-Spleen axis while simultaneously clearing chronic intestinal blood stasis.

Patient Presentation

• Patient: 47-year-old male.
• Main Complaint: Chronic diarrhea lasting for over 10 years, featuring abdominal pain that immediately triggered a bowel movement.
• History: The patient suffered from chronic, refractory diarrhea for more than a decade. His bowel movements were sticky and viscous, accompanied by a feeling of incomplete evacuation (tenesmus). The abdominal pain was consistently relieved right after defecation. He had undergone multiple colonoscopies and stool tests at other facilities, which showed no structural lesions or infectious dysentery, and previous medical treatments had yielded little success. He reported a history of regular alcohol consumption, but no smoking or known allergies.

Examination and Diagnosis

• Conventional Diagnosis: Irritable Bowel Syndrome (IBS). Physical examination of the abdomen was normal (flat, soft, no tenderness or rebound pain, negative Murphy’s and McBurney’s signs). Liver and spleen were not palpable, and bowel sounds were normal (5 times/minute).
• TCM Tongue and Pulse: The edges and tip of the tongue were red, with a yellow, white, and slightly greasy coating. The pulse was stringy, fine, and slippery (弦细滑).

TCM Assessment

The original practitioner interpreted the presentation as Diarrhea driven by Liver and Spleen disharmony (肝脾不和).

Within the framework of Yin and Yang Chinese Medicine, healthy digestion depends on the harmonious, balanced interaction between the Liver (Wood) and the Spleen (Earth). The original report noted that in modern fast-paced environments, chronic emotional stress frequently causes Liver Qi to stagnate. When the Liver loses its ability to regulate the smooth flow of energy, it becomes overactive and “overacts” on or attacks a weakened Spleen. This disruption causes the Spleen’s clear energy to fall (diarrhea) and the Stomach’s turbid energy to stagnate. The red tongue edges (Liver heat) and greasy coating (dampness) confirmed that this Liver-Spleen imbalance was further complicated by the accumulation of damp-heat, likely exacerbated by his alcohol consumption.

Treatment Approach

The primary treatment principle was to soothe the Liver, awaken the Spleen, and clear and resolve damp-heat (疏肝醒脾，清化湿热). Because the condition involved both functional dysregulation (Liver overacting on Spleen) and pathogenic accumulation (damp-heat and stasis), a singular treatment method would be insufficient.

Herbal Formulas and Modifications

• Formula Prescribed (March 19, 2020): The practitioner integrated concepts from three classical formulas: Tong Xie Yao Fang (Formula for Painful Diarrhea), Xiang Lian Wan, and Mu Xiang Bing Lang Wan.
• Action and Composition:
  • Suppressing Liver and Supporting Spleen: Chai Hu and Fang Feng were used to soothe Liver Qi and dispel intestinal wind, while Bai Zhu (20g) strongly fortified the Spleen to stop diarrhea.
  • Clearing Damp-Heat and Regulating Qi: Huang Lian and Huang Qin were added to clear the localized heat and dry the dampness. Mu Xiang and Bing Lang were utilized to heavily regulate Qi and resolve the stagnation in the intestines, directly addressing the feeling of incomplete evacuation and sticky stools.
  • Breaking Intestinal Stasis: Hong Teng (Sargentodoxa stem) at 20g was strategically added to clear heat, resolve toxicity, and move blood in the large intestine.

Follow-Up

• Second Visit and Long-Term Outcome: The patient returned for multiple follow-up visits. The practitioner maintained the same core therapeutic principles, adjusting the herbs slightly based on his real-time symptom presentation. After just over one month of continuous treatment, the source reported that the 10-year chronic diarrhea was fully cured.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the practitioner’s application of the TCM concept that “prolonged illness inevitably leads to stasis” (久病必瘀).

The patient had suffered from diarrhea for over 10 years without structural lesions showing on colonoscopies. While standard TCM approaches to IBS correctly focus on soothing the Liver and strengthening the Spleen, the original practitioner noted that a decade of dysfunction creates micro-circulation blockages in the intestinal collaterals. When these localized pathways are blocked by chronic stasis, neither nutrients nor herbal medicines can reach the diseased site effectively.

By consistently incorporating Hong Teng (an herb classically used for intestinal abscesses and deep stagnation) from beginning to end, the practitioner unblocked these pathways. This cleared the localized stasis without damaging the patient’s foundational energy, demonstrating a profound layer of diagnostic reasoning that ultimately resolved a refractory, decade-long illness.

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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：疏肝醒脾，清化湿热法治疗泄泻案]
• Practitioner: Professor Dong Mingguo (董明国)
• Publication date: October 30, 2024
• Original language: Chinese
• Source link: [View original page]
• ChineseHerb.org version: English translation and editorial adaptation