A 44-year-old man with chronic diarrhea that significantly worsened after a cholecystectomy was managed using a phased herbal strategy to soothe the Liver and strengthen the Spleen.

Case ID: CHC-0025

Case Summary

This case describes a 44-year-old man who presented with a one-year history of loose stools that severely exacerbated after his gallbladder was surgically removed six months prior. The original report documented a conventional diagnosis of bowel dysfunction and a TCM assessment of Diarrhea driven by Spleen deficiency with excessive dampness and Liver Qi invading the Spleen. The patient was managed through a dynamic herbal approach designed to rebuild the digestive system’s ascending and descending mechanics while harmonizing the Liver and Spleen.

Patient Presentation

• Patient: 44-year-old male.
• Main Complaint: Chronic loose stools for one year, significantly worsening over the past six months following gallbladder removal surgery.
• History: The patient developed loose stools approximately a year prior without an obvious trigger. Six months before the consultation, he underwent a cholecystectomy (gallbladder removal). Following the surgery, his diarrhea worsened, occurring 3 to 4 times daily, particularly in the morning. He had not undergone systematic treatment prior to this visit. Associated symptoms included a decreased appetite, a bitter taste in the mouth, frequent flatulence, and shallow sleep (easily awakened). His urination was normal.
• Initial Visit Date: June 1, 2022.

Examination and Diagnosis

• Conventional Diagnosis: Bowel dysfunction (often correlating to functional diarrhea or Irritable Bowel Syndrome).
• TCM Tongue and Pulse: The tongue was red with a white, greasy coating. The pulse was stringy and slippery (弦滑).

TCM Assessment

The original practitioner interpreted the presentation as Diarrhea driven by Spleen deficiency with excessive dampness and Liver Qi invading the Spleen (泄泻 – 脾虚湿盛，肝气犯脾).

Within the holistic framework of Yin and Yang Chinese Medicine, proper digestion requires a frictionless, balanced interaction between the Liver (which governs smooth flow) and the Spleen (which transforms food and fluids). The original report noted that the surgical removal of the gallbladder severely disrupted this Liver-Gallbladder regulatory pivot.

This functional disruption caused the Liver Qi to become volatile and aggressive, “overacting” on the already weakened Spleen. Consequently, the Spleen failed to properly metabolize fluids, leading to an accumulation of dampness (evidenced by the white, greasy tongue coating) that descended as chronic diarrhea. The trapped, overactive Liver Qi also generated localized heat, causing the bitter taste in his mouth, while the heavy dampness generated excessive flatulence.

Treatment Approach

The primary treatment principle was to strengthen the Spleen, transform dampness, soothe the Liver, and regulate Qi (健脾化湿，疏肝理气). The strategy aimed to physically reconstruct the digestive tract’s motility by balancing the hyperactive Liver and the underactive Spleen.

Herbal Formulas and Modifications

• Initial Formula (June 1, 2022): The practitioner prescribed a modified combination of the classical formulas Si Ni San and Tong Xie Yao Fang.
  • Soothing Liver and Resolving Dampness: Bei Chai Hu and Huang Qin were used to soothe Liver depression and clear localized heat. Fang Feng was added to disperse wind, drain dampness, and specifically stop diarrhea.
  • Regulating the Torso’s Qi Dynamic: Jie Geng (which ascends Lung Qi) was paired with Zhi Shi (which descends Stomach/Intestinal Qi). This classical pairing physically restores the body’s vertical energy flow to regulate bowel motility.
  • Strengthening Spleen and Aiding Digestion: Bai Zhu, Fu Ling, Jiang Zhu Ru, and Ze Xie were utilized to fortify the Spleen and safely drain the excess dampness through the urine. Mu Xiang and Jiang Hou Po moved stagnant Qi, while Chao Ji Nei Jin was added to digest food and stop the flatulence.
• Second Visit (June 8, 2022): The patient reported an improvement in the diarrhea, but his sleep remained poor. The practitioner maintained the base formula but added heavy mineral herbs, Duan Long Gu (Calcined Dragon Bone) and Duan Mu Li (Calcined Oyster Shell), to anchor the spirit and stabilize his sleep.
• Third Visit (July 13, 2022): With the diarrhea significantly controlled, the formula was adjusted to a variation of Fo Jin San. Fo Shou and Chao Bai Shao were added to gently regulate the Liver. To deeply repair the patient’s appetite and digestion, Jiao San Xian (a classical combination of charred Hawthorn, Malt, and Medicated Leaven) was incorporated to strongly resolve food stagnation.

Follow-Up

• July 13, 2022 (Third Visit): After the initial phases of treatment, the source reported that the patient’s stools had become formed, and the frequency decreased to a normal 1 to 2 times per day. His appetite noticeably improved, his sleep stabilized, and his urination remained normal. The treatment successfully transitioned from stopping diarrhea to consolidating digestive function.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is its TCM approach to post-cholecystectomy diarrhea, a common complication in Western medicine often attributed to bile acid malabsorption.

Rather than simply using astringent herbs to force the bowels to stop moving, the original practitioner traced the pathology to the disruption of the Liver and Spleen axis. By utilizing Jie Geng and Zhi Shi, the practitioner sought to manually re-establish the ascending and descending rhythm of the entire digestive tract that was lost after the surgery. Furthermore, adapting the formula over the three visits—first clearing the aggressive Liver Qi, then calming the mind, and finally aggressively rebuilding the Spleen’s digestive fire with Jiao San Xian—demonstrates a highly structured, root-level resolution to a complex post-surgical syndrome.

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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: Beijing University of Chinese Medicine Shenzhen Hospital (Longgang) / Guangdong Provincial Administration of Traditional Chinese Medicine
• Original title: [【以案说医】王进东：脾弱肝强泻难止，健脾疏肝正当时]
• Practitioner: Professor Wang Jindong (王进东)
• Publication date: October 17, 2024
• Original language: Chinese
• Source link: [View original page]
• ChineseHerb.org version: English translation and editorial adaptation