Food Retention Triggering Diarrhea

Medical Case Record: Severe Diarrhea Treated with Sequential Herbal Formulas

I once treated an unnamed merchant working at a traditional money exchange house (Qianzhuang) who developed severe diarrhea during summer. The initial physician diagnosed “excessive internal fire” and prescribed Chengqi Decoction (a classic purgative formula containing rhubarb/Da Huang and mirabilite/Mang Xiao for heat clearance). This resulted in dozens of daily bowel movements, causing severe dehydration. A subsequent physician misdiagnosed “constitutional weakness,” administering tonifying herbs. While temporarily stopping diarrhea, this provoked intense chest and abdominal distension, leaving the patient critically weakened.

The Qianzhuang manager, fearing potential workplace death, arranged transfer to a suburban temple through the patient’s cousin (Note: During Ming-Qing dynasties, temples often served as temporary shelters). After 10+ days of failed treatments, the cousin even preemptively purchased a coffin.

At noon one day, the cousin urgently requested: “My cousin is dying. Knowing your pulse diagnosis expertise, could you assess his survival chances? If he might live 15 more days, we plan to return him home – per tradition, dying in one’s homeland is preferable to perishing abroad.”

Upon arriving at the temple chamber, putrid odors made approach difficult, necessitating immediate relocation. The patient lay semi-comatose, unresponsive to stimuli. Pulse examination revealed generally faint, deep and thready pulses with regular rhythm, except the right guan pulse (corresponding to spleen-stomach system) which was abnormally strong and forceful.

Diagnosis: “Classic food-retention dysentery. The initial (used in traditional contexts) cleared intestinal heat but failed to remove food stagnation. Current symptoms should include severe abdominal distension and food aversion when conscious. Despite critical presentation, full recovery remains possible.”

After cousin confirmed symptom accuracy, I prescribed modified Pingwei Powder (base formula with Atractylodes/Cang Zhu and Magnolia bark/Hou Po, augmented with digestive aids Shen Qu and Mai Ya). That night, the patient expelled massive decaying food residues with abdominal decompression and regained consciousness. Next-day follow-up showed weakened pulses, prompting switch to Zhenren Yangzang Decoction ( containing Ginseng/Ren Shen and White Atractylodes/Bai Zhu) for intestinal repair. Three doses completely stopped diarrhea and restored eating. Subsequent 15-day Ginseng Nourishing Pill regimen achieved full recovery.

I only met the patient twice during (used in traditional contexts). Two months later, a well-dressed visitor arrived wearing new (formal hat) and (leather boots) to kneel in traditional kowtow: “You gave me rebirth! Not only cured, my constitution now surpasses before. This debt transcends lifetimes!” I declined gifts and courteously saw him out.

(Modern medical perspective: This case demonstrates TCM’s “layered (used in traditional contexts)” principle – first eliminating food retention (acute management) then restoring bodily functions (constitutional repair). Chengqi Decoction serves acute purgation, Pingwei Powder addresses digestion, while Yangzang Decoction and Ginseng Pill comprise systemic rehabilitation.)