Using Purgation to Stop Diarrhea? Treating a Young Taiwanese Man’s “Recurrent Diarrhea” with a Purgative

A young Taiwanese man in his twenties originally came to the clinic seeking treatment for other issues, but the first thing he said today was: “Doctor, I ate too much spicy food at a dinner a few days ago, and now I’ve got this rushing diarrhea—I can’t stop running to the toilet.” After taking his pulse, I asked him, “Did you binge-eat? It wasn’t just the spice, was it? And have you had any chest tightness or heart discomfort?” He replied, “Doctor, it’s weird—yesterday I suddenly felt a stabbing pain in my heart once, but no chest tightness.” I said, “Take one dose of a ‘purgative formula,’ then report back to me.”

That afternoon, I received a WeChat message from him: “Now I’m feeling chest tightness.” I said, “Keep taking the medicine.” Two days later, when I asked again, the diarrhea had stopped and the chest tightness was gone.

The “purgative formula” I gave him was Da Cheng Qi Tang (Major Order the Qi Decoction). Da Cheng Qi Tang is typically used to treat Yangming fu excess patterns, especially when someone hasn’t passed stool for days—it has very strong downward-draining power. So why can it also stop diarrhea? The Treatise on Cold Damage (Shang Han Lun) says: “When Yangming and Shaoyang diseases combine, there will surely be diarrhea… If the pulse is slippery and rapid, it indicates undigested food. One should purge with Da Cheng Qi Tang.” In other words, although the patient suffers from painful diarrhea, the slippery, rapid pulse indicates accumulation inside the intestines. At this point, you shouldn’t just think about stopping the diarrhea—by expelling the food stagnation, the diarrhea will naturally stop.

Although the patient himself said that eating chili peppers caused his diarrhea, his pulse at the right guan position was deep, slippery, and forceful. Clearly, the pulse revealed the true mechanism of disease, and thus one dose was effective. As for the chest tightness and heart discomfort, they were also caused by stagnation in the middle burner obstructing the qi circulation, which was likewise reflected in the pulse. Once the underlying mechanism was resolved, these accompanying symptoms dissipated as well.

“Using purgation to stop diarrhea” is actually one of the important treatment principles in Chinese medicine. Beyond diarrhea, there are many other situations where this principle applies. For example, in gynecology, if prolonged uterine bleeding (xiañgè) is caused by blood stasis, one must first use a downward-draining method to eliminate the stasis before one can truly stop the bleeding.

Case No. 088