Case history – urgent explosive diarrhea


Date of birth 1945

Married +3


Main complaint: chronic diarrhea

Unexplained diarrhea for the last 10 years, Patient has passed all conventional tests but no finding’s.

The diarrhea occurs several times a day and with urgency.

Medical history

Up until 10 years ago he ran a big business, drank coffee all day and did not eat anything till the end of the day. Once home he used to eat from supper time up until bedtime. He noticed the diarrhea only after retirement.

The past year he suffered from coughing with pneumonia 5 times, treated each time with antibiotics. He notices that antibiotics worsen the diarrhea.

From childhood suffers from overweight.

Diagnosed with Melanoma (skin cancer) treated surgically.

Both knees have been replaced surgically.

Digestion function:

Bowel movements: 9-10 times a day, pasty watery, sometimes uncontrollable, feeling pressure in the abdomen before bowel movement, but no pain. Gas and diarrhea do not smell. Occasionally feces are solid, large, with shape. Feels an urge to evacuate the bowels immediately after eating or walking. 

Appetite: Hungry often, need something to chew on all the time. There’s no problem not to eat, but when food is available it’s hard to resist. It is not a physiological appetite but a mental need. Eats a lot, large amount, feels tired after eating, wants to sleep, but rarely sleeps during the day.

Patient Drinks:

Coffee, espresso with goat’s milk, 2-3 times a day, dislikes cold water or cold soda, In general not so thirsty and does not drink much.

Patient original Menu:

He gets up at 5:30 AM

Drinks coffee with milk

Breakfast 8:00 

Goat yogurt with berries or strawberries and a little homemade granola and more coffee


Nothing to eat, drinks water or tea

Lunch 14:00 

Vegetable soup (zucchini, carrots, pumpkin, sweet potato), some kind of protein such as lentils, meatballs, turkey breast, chicken or fish, baked sweet potato, cooked cabbage in tomato juice, rarely some rice.

Afternoon 17:00 

A coffee and something sweet such as a granola energy bar or Cookie.

May feel the uncontrollable need for chewing something around this time and will find something else to eat cold from the fridge (for example cold fruit).

Dinner 20:00 

Vegetable salad tomato cucumber and salt, homemade tahini spread 1-2 spoons, an egg, and 2 slices of whole grain bread with avocado.

Night 22:00

Soy yogurt with cold fruit or some ice cream. 

Facial & body diagnosis

Lower eyelid slightly swollen.

Tongue is relatively pale with a white coating in the center. 

Hardly perspires, bothered by humidity. 

Nails of feet infected with fungus. 

Pulse: A little slow.

Spleen Pulse position is very tense and hard.

Pericardium pulse position empty.


All signs show that the digestive system is obstructed by internal cold and damp-phlegm, causing also the recurrent pneumonia and the fungal infection.

Chinese medicine diagnosis: Spleen Yang Deficiency with Phlegm accumulation.

Ayurveda diagnosis: slow digestion (Manda Agni) with Phlegm accumulation (Ama).

Treatment Strategy:

Tonifying Spleen Yang and transform phlegm:

Increase heat, dryness and lightness

Dietary suggestions:

  1. All meals should be warm and well cooked
  2. All meals should be light; for example separate carbohydrate from proteins, eat less food per meal, eat simple meals with less ingredients.
  3. All meals Spiced with pungent and slightly bitter taste
  4. No snacks
  5. No coffee because of its purgative effect
  6. Avoid eating after dinner
  7. Avoid cold food or cold drinks

9:00 Breakfast:

  • Buckwheat and steamed / baked vegetables
  • Quinoa “Tabula” with small pungent bitter green leaves  

12:00 snack:

  • Best avoid
  • lettuce leaves
  • baked apple and cinnamon

14:00 Lunch:

  • Basmati rice, 30% 
  • Steamed vegetables, 50% 
  • Chicken breast or cooked lentils, 20%
  • Small glass of green tea

17:00 Snack:

  • baked apple and cinnamon

19:00 Dinner:

  • Green omelet and basmati rice 
  • Steamed or baked vegetables and basmati rice

22:00 before bedtime:

  • Avoid

Herbal supplementation: 

Chitrakadi Vati: 2 pills, 3 times a day, before meals


Patient reporting:

Feels fine, the dietary change is not easy, but the results very good. Lost weight, and as for the bowel movements, almost all were solid, only a few diarrhea. Diarrhea came with the same urgent need, but happened only once or twice. There is a lot of gas, much more than before, and many times a feeling for evacuation but nothing comes out except gases.

The diarrhea occurred after eating for dinner baked salmon with cauliflower, zucchini and pickles 

The first days without coffee suffered from headaches, but overcame it.

Diet in practice by patient:

Every morning he ate buckwheat only

For lunch he ate either vegetable soup with pearl barley or fish fillet/chicken breast roasted on a striped skillet with lentils stew and boiled carrots or baked pumpkin.

Afternoon snack a baked apple or pear 

Evening: vegetable omelet with Parsley, onion and dill, and baked cauliflower.

Drink: only water. He did not like the taste of Infusions with spices.

Misses the raw vegetables he used to eat for dinner.

New recommendations:

We talked about whole rice and lentils with green salad.

Separate proteins at noon (either lentils or chicken/fish).

Vegetable barley soup should be made thick. 

More baked vegetables, mainly carrots

In the evening eat the green omelet with buckwheat or quinoa.

Keep taking the pills regularly


Patient report:

No diarrhea, only solid feces.

Weight is still dropping. The diet is hard for him, feeling powerless, lost the joy of life.

The craving for food did not disappear, but because he decided to comply with the treatment, he stuck to the plan almost without any deviations.

Occasionally there is still a feeling of bowel movement, but only gas is released. He has less gas in general, and less fragrant.  

New recommendations: 

The objective is to expand the diet so the patient will feel more satisfaction and joy from the food, while still reinforcing the digestive capacity (Spleen Yang).

Additions to the diet: 

Occasional breakfast: Spelt toast with thin layer of avocado / olive oil and hyssop / homemade pesto without nuts and cheese. Or Crisps (buckwheat or rice cakes) with a thin layer of spiced avocado spread

One small black coffee a day, after breakfast

Barley grits for lunch with lentils 

Add a grain to dinner omelet, basmati brown rice or buckwheat.

Add lemon to meals if desired

Add some stevia as sweetener for cooked carrot salad. 

Herbal supplementation: 

Bu Zhong Yi Qi Tang


Patient reporting:

No diarrhea, but a lot of gas. 2-3 bowel movements a day, not urgent, firm texture. Occasionally feels the urge to defecate but only gas comes out.

Still feeling pretty tired, he has no energies. From the morning there is no desire for anything, no energies to do anything. This is his general mood. There is no joy of life.

Still losing weight and gets a lot of compliments, dropped 8-10 kg.

He thinks he can not stick to the diet treatment plan for the long run. The desire for food is great and very difficult for him, especially when he encounters special situations like restaurants, guests from abroad, tried to deviate from the recommendation as little as possible, but it is very difficult for him. Even on days when he did not completely stick to the plan, he did not get diarrhea.

But physically, he knows he does not lack food. Sometimes he is missing something sweet after dinner, so he can take another apple or pear.

Still does not feel lightness in the body despite the weight loss.

It’s been a long time he has been taking half a sleeping pill twice a night, before going to sleep and then again at 2:00 AM when he wakes up. Half a pill is good for 3-4 hours of sleep. Things have changed and now he falls asleep very easily without the first half pill, and wakes up at 4:00 AM the first time and then does not take the second half pill either since it is too late for that, so no more sleeping pills. 

The blood pressure was high and he used to take medicine for it. In recent weeks the blood pressure was balanced without the medicine, so he quit.

My recommendations:

We talked about guidelines for eating out, quantity and simplicity.

Herbal supplement:

Hingwashtak Vati


Patient reporting:

The weight remains stable and the digestion is stable and good. But there is no energy, no enthusiasm or joy of life.

The menu is stable, occasionally insignificant irregularities. Then he returns back on track.

There’s gas, there’s no change in it, but got used to it. There are many times when there is an urge to defecate and it turns out to be just gas.

Sleep: falls asleep very easily and instantly. There are many nights that he skips the sleeping pills, the diet improved his sleep and helps to prolong sleep, he can sleep for five to six hours at a time.

Training: tries to go bike riding 2-3 times a week. He feels much more tired than before. At the end of the ride he feels tired. A year ago he was much fitter and much less tired. Nonetheless he can still ride for two hours.

My interpretation of the patient’s lack of energy and joy:

The hedonistic way of eating and the lust for food since retirement masked the sense of lack of joy and purpose in life, while causing various illnesses. Food was an enjoyment which compensated for the emotional and mental depression marked by losing meaning, making life after retirement bearable.  Now that the comforting food and the overeating have fallen, the sense of lack of joy and meaning has magnified and cannot be suppressed any more.  


Patient reporting

Digestion works well.

Occasionally deviates from the recommendations, especially when he was not at home, but apparently he did not exaggerate too much, as nothing bad happened. The next day he always goes back to the diet plan.

There’s a lot of gas all the time.

The weight loss pretty much stopped.

He still feels the lack of strength and zeal. If he had released the reins he would have wanted to eat everything!

There is no change in the mood for the time being. Nothing interests him, friends, newspaper; it’s all a waste of time…

He goes out for a bicycle ride, it’s all right and he enjoys it, but when he returns it does not change his mood. There is no drive to sit and concentrate for something. Went to see the sunset at the beach, but is means nothing for him. There is nothing that he wants to reach for or achieve. There is no purpose to his life.

My recommendation:

How to find meaning to life?

I suggested him to venture on a quest for self-exploration; to leave his comfortable and degenerated current circumstances and travel to an exciting destination, to reconnect to himself and reignite the inner journey of a meaningful life. May be go trekking in Nepal?


Something is moving in his inner world. Started to inquire and find interest in a bicycle trip in Europe, and is checking the option to travel to Nepal to trek with his son.


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