38-Year-Old Male Successfully Treated for Chronic Diarrhea Caused by Spleen Deficiency and Dampness Accumulation

Summary: A 38-year-old male experienced persistent diarrhea for over a year, with symptoms worsening recently. Consumption of spicy foods or beer led to increased bowel movements, watery stools, fatigue, shortness of breath, and easy exhaustion. After Traditional Chinese Medicine (TCM) diagnosis, the condition was identified as spleen deficiency with dampness retention. The patient was treated using modified Si Jun Zi Tang (Four Gentlemen Decoction) for one month, resulting in significant improvement in diarrhea and tongue indentation. Follow-up over two months showed no recurrence.

Basic Information: Male, 38 years old
Condition: Spleen Deficiency with Dampness Retention
Hospital: First Affiliated Hospital of Nanchang University
Date of Visit: March 2022
Treatment: Modified Four Gentlemen Decoction
Treatment Duration: One month outpatient care with two-month follow-up
Outcome: Improved bowel function and reduced tongue indentation

Initial Consultation

The patient had suffered from recurring diarrhea for more than a year, with episodes increasing to 3–5 times daily. Recently, even minor intake of spicy food or alcohol triggered loose, watery stools. He also experienced fatigue, shortness of breath, poor appetite, lack of thirst, normal urination, pale tongue with white coating, tooth marks on the tongue, and weak pulse. Gastrointestinal endoscopy revealed chronic superficial gastritis, and ultrasound confirmed fatty liver. Physical examination indicated central obesity. Western medicine diagnosed chronic diarrhea and irritable bowel syndrome (IBS), while TCM identified it as spleen deficiency with dampness accumulation.

Course of Treatment

Based on the TCM diagnosis, treatment focused on strengthening the spleen, resolving dampness, and stopping diarrhea. The prescription included modifications of the classic Si Jun Zi Tang formula with ingredients such as Codonopsis root, Atractylodes, licorice, Coix seed, Poria, hyacinth bean, tangerine peel, Amomum fruit, Chinese yam, lotus seed, chicken gizzard lining, and fried barley malt. One week later, the patient's stool became softer and more formed. His energy improved, and his appetite slightly increased. However, he still experienced mild abdominal pain, cold limbs, and sensitivity to cold—indicating internal cold deficiency. Dry ginger and cinnamon bark were added to warm the middle jiao and relieve pain. By the second week, his complexion improved, stools normalized, and abdominal discomfort eased. His appetite increased, so chicken gizzard lining and fried barley malt were removed from the formula. At the third visit, his bowel movements were nearly normal, occurring once daily, and the tooth-marked tongue had visibly improved.

Therapeutic Outcome

The patient exhibited classic signs of spleen qi deficiency including fatigue, shortness of breath, and poor appetite, along with dampness symptoms like loose stools and a swollen tongue. Initially, there was no clear sign of yang deficiency, hence the focus was on strengthening the spleen and resolving dampness. As new symptoms emerged, warming herbs were introduced. By the fourth consultation, most symptoms had resolved, demonstrating the effectiveness of pattern differentiation and herbal modification in TCM. After one month of treatment, the patient's digestive health improved significantly.

Recommendations for Prevention and Lifestyle

The patient's condition was likely exacerbated by long-term consumption of cold foods and alcohol, which impaired spleen function and led to internal dampness. This often manifests as loose stools, undigested food particles, and immediate bowel urges after meals—common issues among men who frequently consume chilled beer during summer. Chronic spleen deficiency can lead to yang deficiency symptoms such as early morning diarrhea or sexual dysfunction. It is essential to avoid raw, cold, spicy, and alcoholic substances, quit smoking, and maintain a bland, easily digestible diet.

Reflections on Clinical Practice

There are numerous effective formulas for strengthening the spleen and boosting qi, such as Si Jun Zi Tang and Shen Ling Bai Zhu San. However, individual constitution and symptom complexity require careful adjustments. In this case, the patient developed internal dampness due to severe spleen deficiency. Special attention must be given to dietary habits, especially avoiding cold foods during summer, which can further harm the spleen yang and lead to excess internal cold.