Daybreak Diarrhea

Medical Record Number: 8952809,

Mrs. Zhou, 55ys,

Diagnose: daybreak diarrhea

Chief Complaint:recurrent morning diarrhea for over 5 years

Medical History:The patient has daybreak diarrhea with undigested food for over 5 years, 2-3 times a day, with no abdominal pain, he also has fatigue, low spirit and short of strength, low voice, aversion to cold especially in neck, profuse sweating but aversion to wind, recurrent mouth ulcers, no difficulty in fall sleep but wake up too early, has soreness and weakness of waist and knees.

Tongue and Pulse:Tongue is pale and enlarged with tooth marks on margin and thin coat. Pulse is deep, rapid; and weak if pressed heavy.

Diagnosis:diarrhea before dawn, fatigue syndrome

TCM Differentiation:Deficiency of spleen and kidney yang, essence and blood depletion

Treatment Principle:Warm and tonify Yang inkan, guide fire to its origin

Prescription:Modified Qian Yang Feng Shui Dan

Rou dou kou 10g

Wu wei zi 9g

xiao hui xiang 10g

Wu yao 10g

Gan jiang 10g

Gui zhi 10g

fu ling 15g

Lu jiao suang 15g

Zhi gan cao 6g

duan long gu 30g

duan mu li 30g

Zhi fu pian 10g

lu gen 20g

Huai xiao mai 30g

cu gui jia 24g

Sha ren 6g

huang hai (burned) 10g




Spleen and kidney yang deficiency causes failure in decomposition, therefore water and grain wandered together in large intestine that resulted in morning diarrhea with undigested food for several times a day. Spleen qi insufficient causes dysfunction in transportation and transformation of grain qi, fatherly leads to deficiency of defense qi, nutrient qi and ancestral qi, so patient felt fatigue, short of strength and laconic speech.

Due to insecurity of defensive yang, weakened in warming body, nutrient-defense disharmony, and somehow three of yang meet in the neck, therefore, the patient had profuse sweating but aversion to wind and cold, especially in the neck. Yang could not get into yin, makes vacuity interior and yang externally oversteps or upward perversion, resulting in recurrent mouth ulcer and poor sleep. Deficiency of essence and blood causes low back pain, fatigue and weak pulse.

In this formulae,Rou dou kou andlu jiao shuangwarms spleen and tonifies kidney;xiao hui xiang,wu yao,andgan jiangwarms middle Jiao and dissipate cold;wu wei zibenefits kidney for  securing and astringent;fu linginvigorates spleen and drains damp;gui zhiwarms Yang and promotes Qi transformation, harmonizes nutrient-defense and disinhibit water-dampness;zhi fu zinurtures and tonifies true Yang in the kan, secure fire of life gate; gui zhi stops sweating due to Yang deficiency;duan long guandduan mu li is tosubdue Yang into Yin to calm spirit, and regulate bowel movement,huai xiao maistops sweating;cu gui jia,which has essence of water and earth, is an affectionate animal product, to nourish essence and blood, consolidate Yin and consolidate Yang;sha renwarms middle Jiao and move Qi, small dose ofsha renis good at promoting Qi and benefits kidney;lu genandhuang baiclears the flaming up deficiency fire of heart-kidney, and prevent super activity of ministerial fire.