Parents and caretakers who have had to deal with infantile diarrhea were probably told by the baby's Western doctor that the diarrhea was not considered a disorder, but a symptom of an underlying problem -- very often gastroenteritis, seen more often among children who have been bottle-fed than those entirely breast-fed.1 In traditional Chinese medicine (TCM), infantile diarrhea is considered a common digestive disease in children, with an especially high incidence among babies under two years of age, whether bottle- or breast-fed.
The younger the baby, the higher the incidence of diarrhea, and the more severe the pathological conditions will be.2
The difference between Western and Eastern views is mainly one of nomenclature. In Western medicine, diarrhea is a symptom; in Eastern medicine, it is a disease. Both are concerned ultimately with the prevention of dehydration. Most cases of diarrhea in infants are of an acute form, which carries the risk of rapid dehydration (especially when accompanied by vomiting); it can be fatal unless countered quickly. Chronic forms are uncommon, as, for example, in cystic fibrosis. Some causes of diarrhea, according to Western medicine, are bacterial and viral infections; parasitosis; gluten-induced enteropathy; cystic fibrosis; sugar malabsoption; and allergic gastroenteropathy.3 Diarrhea is defined as increased frequency, fluid content, or volume of fecal discharge.
According to TCM, possible causes of diarrhea could be:
Spleen deficiency; or
External wind cold invasion.
Western and Eastern medicines both agree that a proper diet is of utmost importance, mother's milk being the preferred diet for an infant. As malnutrition is a portentous possibility of diarrhea unchecked, the TCM practitioner may first consider the spleen and stomach. A dysfunction of the spleen and stomach can severely impair the transportation and transformation of food to the baby's body. These two organs, properly functioning, can remove food stagnation for example, thus ensuring the proper absorption of essential nutrients. Damage to the spleen and stomach would inevitably lead to malnutrition.
The baby's diet, whether milk or food, should be regular, consistent and bland. If it is food, it should be easy to digest to ensure proper functioning of the spleen. A malfunctioning spleen leads to improperly digested or undigested food. This and the damp thus formed can combine to cause diarrhea. Exposure to pathogenic factors, especially wind; cold; summer heat; and damp, disturb the spleen and stomach, resulting in diarrhea. An illness can weaken the spleen and stomach, affecting the function of receiving; digesting; transporting; and transforming food. Again, the water and damp thus produced can cause diarrhea.
Infantile diarrhea is characterized by increased bowel movements with loose or watery stools, or stools like "stirred egg soup."4 Infantile diarrhea can occur in any season, but it is more commonly seen in summer and autumn.
Particular clinical manifestations can help differentiate the cause of diarrhea:
Food stagnation (or retention of food) is probably the most common cause of infantile diarrhea. It is due to overfeeding or overeating of milk or food. Instead of being digested, the food accumulates and putrefies in the stomach and intestines. Impairment of the function of the large intestine (LI) in food transmission produces damp and heat, which explains the stool's foul odor: a smell like spoiled eggs. The stool could be yellowish in color. Overlong retention of undigested milk or food produces heat, so there could be a slight fever or tidal fever in the afternoon with crying and irritability. With the qi's inability to circulate smoothly in the large intestine, abdominal distention, borborygmus (and eructation) and pain would result, alleviated only by movement of the bowels. Crying from the pain and discomfort of the stagnation could alert the mother or caretaker of the baby's needs to empty the bowels. There could be a burning sensation in the anus; thirst; night crying; restless sleep; sallow complexion; dry skin; sparse hair; and vomiting. Because of the internal stagnation, the umbilicus could protrude from the baby's "pot belly."5 Dysfunction of the spleen could cause the baby to lose its appetite (anorexia). Diarrhea could occur as many as five or six times a day, even up to as many as 10 to 20 times a day.6
The tongue would have a thick, slimy or dirty and sticky, slightly yellow coat. There could also be a complete loss of coating. The pulse would be slippery and rapid. The baby could also have a "purplish engorged vein at the base of the index finger."7 Treatment would involve dispersing the food; moving the stagnation; pacifying the stomach; and aiding digestion.
The baby could benefit from having its belly massaged in a circular clockwise motion. This would promote movement of the stagnant food in the intestines. A recommended herbal formula would be bao he wan.8
Damp heat may accumulate when the spleen fails in its transportation function, so there would be loose bowels (greenish or yellowish in color), with a putrid smell; redness and burning around the anus; dry mouth; fever; thirst; abdominal distention; and pain. Anorexia could result from impairment of the spleen and stomach functions of digesting and transporting refined nutrients that nourish the zang-fu organs; qi; blood; skin; muscles; and hair. There could be a sallow complexion; emaciation; scaly, dry skin; and sparse hair. The baby could have bad breath. If there are parasites in the abdomen (parasitosis), there could be abnormal food cravings.
The tongue would have a slimy yellow coat, and the pulse would be weak, slippery and rapid. A treatment plan would be to clear the heat, eliminate dampness and pacify the lower burner.
There should be an avoidance of all greasy, fatty and hot/spicy foods. An herbal formula such as ge gen qin lian tang would be used, with modifications. Chinese pediatric massage has not proved effective for this condition.9
Food stagnation and a pattern of damp heat are considered conditions of excess. If acupuncture is applied, points may be selected from the following:
Clears damp heat from lower burner
Stimulates desceding of stomach qi; harmonizes the stomach; eliminates heat
Front mu of stomach; stimulates the descending of stomach qi; tonifies the spleen to resolve damp
Spleen deficiency is due to impairment of the transportation and transformation function of the spleen, producing recurrent bouts of diarrhea. The spleen is too weak to digest foods and liquids properly, and the spleen qi is impaired as well (diminishment of blood). Ingestion of meals is frequently followed by expulsion of stools containing white, milky masses of undigested food. There can also be watery stools; cold limbs; vomiting; anorexia; fatigue; weakness; abdominal distention that can be worse after eating; emaciation; sallow or pale complexion; dull and pale lips; and a blue vein at the end of the nose.12 The tongue is pale with a thin, white or slimy coating. In cases of yang deficiency, the tongue will be pale, delicate and swollen. The pulse is deep and forceless. Treatment would be to fortify the spleen and warm the middle jiao.
A Chinese herbal formula would include qi wei bai zhu san. If food is given, it should be cooked and warm. Give no chilled or frozen foods or liquids. Feed a clear, bland diet, with little or no sugar. A homemade porridge made from any very bland-tasting, spleen-strengthening Chinese herbs would be beneficial. Grind them into a powder and cook into a gruel. These Chinese herbs include shan yao (radix dioscoreae oppositae); fu ling (sclerotium poriae cocos); yi yi ren (semen coicis lachryma jobi); and bai bian dou (semen dolichoris lablab).13
If acupuncture is applied, points may include:
Front mu of large intestine; regulates the function of the large intestine
Back shu of large intestine; regulates the function of the large intestine
Regulates qi; relieves stagnation
Sp 3, UB 20 (back shu of spleen) and ST 36 (lower he-sea of stomach and command point of middle jiao)
All work together to invigorate the function of the spleen in transportation and transformation
Tonifies spleen qi
Sp 9, Ren 9, and ST 28
All work to resolve dampness in the lower burner
Tonifies spleen qi
Back shu of stomach; tonifies spleen qi
Front mu of spleen; invigorates spleen
External wind cold invasion may be the least common form of infantile diarrhea. It is due to the baby's having caught a cold.14 As well as the common cold symptoms of fever, aversion to cold, stuffy/runny nose, cough, sneezing, scratchy throat, and chilled limbs (chills more than fever), there could be lassitude; pale complexion; lack of appetite; lack of thirst; abdominal pain; borborygmus; and gurgling noises in the intestines. The tongue could have a thin white coat with a slimy moss. The pulse could be fine and soggy, or superficial and tense. The treatment plan would be to disperse the wind and cold; release the exterior; and transform the dampness.
An herbal remedy would be huo xiang zheng qi san with modifications.15 Acupuncture points could include the following:
Disperses wind cold; releases the exterior
Releases the exterior; expels wind
Source point of large intestine; releases the exterior
For any type of diarrhea, ear acupuncture may be considered. Points of the small intestine, large intestine, stomach, spleen, sympathetic nerve and ear shenmen would be applicable.16
Infantile diarrhea damages the baby's yin and yang. Unchecked, it will eventually lead to diminishment of qi and blood. It is important to take precautionary measures even if the baby is having persistent loose stools. Control of the diet is essential. In cases of mild diarrhea, feed in small portions. In advanced cases, space the feedings about eight hours apart, and always allow drinking water. As the baby improves, give (mother's) milk or easy to digest foods in small amounts. If the diarrhea persists for more than 48 hours, consider consulting a Western physician.17
Clayman CB (ed.) The American Medical Association Home Medical Encyclopedia. New York: Random House, 1989, p. 356.
Huide J. Essentials of Traditional Chinese Pediatrics. Beijing: Foreign Languages Press, 1990, p. 87.
Beers MR, Berkow R (eds.) The Merck Manual of Diagnosis and Therapy. Whitehouse Station: Merck Research Laboratories, 1999, p. 2108.
Huide, p. 87.
Xinnong C (chief ed.) Chinese Acupuncture and Moxibustion. Beijing: Foreign Languages Press, 1993, p. 469.
Flaws B. Keeping Your Child Healthy with Chinese Medicine: A Parent's Guide to the Care and Prevention of Common Childhood Diseases. Boulder: Blue Poppy Press, 1996, p. 77.
Flaws B. A Handbook of TCM Pediatrics: A Practitioner's Guide to the Care and Treatment of Common Childhood Diseases. Boulder: Blue Poppy Press, 1997, p. 91.