An Integrated Chinese-Western Protocol for Refractory Diarrhea

Irritable bowel syndrome, noninfectious diarrhea, intestinal dysfunction caused by surgery or chemotherapy in cancer patients, and radiation enteritis can all cause intractable acute or chronic diarrhea that responds poorly to ordinary medications. They require integrated Chinese-Western treatment, combining several drugs. I have recently used the following protocol for such problems with some success, and share it for readers’ reference.

I used compound glutamine capsules, Fuke’an tablets, and Sishen pills together to treat diarrhea unresponsive to conventional methods; in severe cases I also administer Huanglian Jiedu Decoction for 1–7 days, and add Yunnan Baiyao or Huaihua Powder when bloody stools appear. This combined regimen can resolve refractory diarrhea that a single approach cannot.

Compound glutamine capsules contain glutamine, ginseng (Renshen), Poria (Fuling), Atractylodes (Baizhu), and licorice (Gancao). Formerly called Gucen Chang’an capsules, it is an integrated Chinese-Western patent combining glutamine with the Chinese formula Shenling Baizhu Powder.

It is an intestinal mucosal protectant and function enhancer: it promotes repair of damaged mucosa and restoration of function, strengthens the mucosal barrier to block or reduce entry of intestinal bacteria and toxins into the blood, and improves intestinal absorption, secretion, and motility. Shenling Baizhu Powder is the representative Chinese formula for spleen-deficiency diarrhea; its main action is to bolster the root and strengthen the patient’s general condition.

Fuke’an tablets are a modern empirical formula distilled from folk remedies for diarrhea and abdominal pain; its main ingredients include Niutengteng (Jasminum elongatum), Jiubiying (Ilex rotunda), Huotanmu (Polygonum chinense), and pomegranate rind. These are not common herbs, and in decoction form they are hard to buy from pharmacies.

Fuke’an tablets markedly inhibit many intestinal pathogens causing diarrhea; in Chinese terms they clear heat and resolve toxicity. Some physicians may think it should not be used with tonics like ginseng, but in practice the combination is fine. For chronic diarrhea, Shenling Baizhu Powder plus Fuke’an tablets achieves both supporting the upright and dispelling the evil, working better than either alone.

Sishen pills treat “five-watch diarrhea” due to spleen-kidney yang deficiency; its ingredients are Schisandra (Wuweizi), Psoralea (Buguzhi), nutmeg (Roudoukou), and Evodia (Wuzhuyu). Note that the market has both Sishen pills and Roudoukou Sishen pills; I recommend the simpler Sishen pills. Roudoukou Sishen pills contain poppy capsule (Yingsukke) and other ingredients, and long-term use can cause dependence. Sishen pills stop diarrhea well, but for intractable diarrhea their effect alone does not last.

Diarrhea from radiation enteritis, IBS, and similar conditions is protracted and tends to recur; patients with a long course should take the medicine for a longer time. After symptoms clear, the dose should be reduced to one-third to one-half and continued for 1–3 months to consolidate effect and reduce relapse.