Say you were just visiting a country with bad water like Guatemala, or were swimming in a lake with pollution or had the Louisiana fish fry for Mother’s Day where the spicing could cover up any off flavors. And somehow you ended up with hot watery diarrhea that wouldn’t stop, even after days of the BRAT diet (Banana- astringent with potassium, Rice-absorbent and easy on the stomach, Applesauce- colloidal with its pectins and Tea- astringent with its tannins, or depending on your interpretation, Toast to absorb.) You need something stronger.
This entry is about how to formulate herbs for a more effective cure, but it is also on diarrhea, so if you are squeamish, be advised.
First off, while there may be wisdom in starting antimicrobial herbs early on, it is a good idea not to take antidiarrheals until what needs to get out has a chance to get out. DuPont and Homick found in 1973 that treating Shigella- caused diarrhea with Lomotil extended the course of the fever because diarrhea itself is a protective mechanism. But diarrhea is the number two killer of children under five and kills over 1.1 million people over the age of 5 annually. It imbalances electrolytes which can kill, especially the elderly and it dehydrates. It isn’t something to leave untreated. I’ll give it three days before looking at an antidiarrheal strategy.
What exactly happens? First an organism, usually microbial but sometimes a parasite like giardia, upsets the digestive tract. You may become feverish. Water stops being absorbed from the small intestine, allowing it to flush out organisms and associated toxins, along with a panoply of necessary electrolytes. Even if you drink, you tend not to hydrate your tissues. The liver’s secretion of bile is off and toxins secreted by the organism stress the liver’s detoxification pathways. The bacterial overgrowth, burrowing of a parasite like giardia or entameba histolytica into the intestinal walls or composition of the fluids can upset the ecology of your gut bacteria. Your anal sphincters may be stressed. You need an herbal formula that will deal with all of these issues.
So what properties should such a formula have? It should be antimicrobial since you want to deal with the first cause, although that alone may not be enough. It should absorb fluids to get a more solid stool and to reduce pressure on the sphincters. It should astringe fluid loss. It should replace minerals and allow hydration. It should support the liver.
And it should be diuretic. Diuretic? Aren’t I losing enough fluid through the bowel? You may not have noticed that you stopped peeing with all that fluid loss. And if you continue to lose fluid through the bowel, you will not hydrate. One of my herbal professors used to tell of saving the life of a hospitalized baby dying of diarrhea by injecting her with a diuretic.
Now think of how you want to make up the formula: raw herbs decocted or infused into a tea, tinctures or fluid extracts, granules or pills. If you are using raw herbs, you need someone in the home who isn’t affected to cook them up and administer them. Tinctures are lousy sources of minerals, so you will need to supplement your electrolytes. Granules have electrolytes and are easily customized, but tend to be restricted to Chinese herbs, with a few exceptions. Pills are not well absorbed in a body with diarrhea, don’t allow your taste to stimulate body secretions but may be the most tolerable way to take strong antiparasite herbs. You are allowed more than one method.
So first, I would look at antimicrobial and antiparasite herbs like black walnut, Artemesia annua, wormwood, cloves or quassia. These tend to be intensely bitter, cold and to affect the liver as well as the parasites. I’d add to that one of the berberine-rich herbs like coptis, phellodendron or goldenseal which are antimicrobial but also stop diarrhea and dysentery. The antimicrobials would be assisted by an alterative herb which enhances nonspecific elimination. For this I’d use oregon grape or echinacea if I wanted a stronger antimicrobial kick. And I would use plantain or calendula for healing the internal mucosa. If there is bleeding, add notoginseng (san qi) or shepherd’s purse. If there is pus, add pusatilla (pasque) flowers. Whole herb dandelion will be diuretic, will add potassium if given in a raw, granule or pill form and the root’s inulin will aid the gut bacteria in re-establishing balance. Plantain seeds or cornsilk are diuretics which can be found in granule form. Avoid irritating diuretics like uva ursi, since you are already irritated.
Because I want the minerals, I’d throw a handful of nettle leaves in chicken-miso soup with rice. Boil the nettles, but add the miso for probiotic effect after it cools down a bit. This will replace fluids and electrolytes while being a bit astringent. You could use astringent herbs in the formula instead, but go for the ones with tannins- barks or tea, and avoid acid astringents which will upset your stomach.
It also helps to take herbs rich in fiber, like marshmallow or slippery elm which will absorb water and lock it into solid form. Since these herbs tend to clump, I usually stir in a heaping teaspoon or two of powdered herb in applesauce which covers up the glop factor, but if you prefer it as a tea, drink it right away. Alcohol tends to inactivate the polysaccharides, so I don’t put these herbs into tinctures. The herbs will also help feed the probiotic organisms.
As you can see, there are several ways to reach your goal, and many herbs serve multiple functions, but I thought I’d give a sample protocol that would work for a hot, watery traveler’s diarrhea without blood or pus.
Tincture – 1/4 teaspoon 4-5 times a day
3 parts Artemisia annua or Qing hao -antimicrobial, aromatic bitter, cold
1 part Black walnut- antiamoebic, extremely bitter, cold and astringent
2 parts Coptis-bitter, antimicrobial, antiviral, antiamobic, alterative, cold, stops diarrhea
2 parts Plantain leaf- antimicrobial, vulnurary, demulcent with affinity for GI mucosa
2 parts whole Dandelion fluid extract – diuretic, bitter and sweet, cool
1 part Calendula-gastroprotective, antinflammatory, antimicrobial, antispasmodic
Soup: Chicken-miso soup with nettle leaves
Other: Applesauce with slippery elm powder. Probiotic foods or supplements.
If you think you might have been exposed to giardia, you will want to treat it aggressively and early because when it burrows into the intestinal wall, it can be extremely difficult to dislodge and can become a chronic condition. Giardia usually comes from polluted waters or fecal contamination. It can be treated with herbs alone, although for children western meds may be easier because the herbs are usually intensively bitter and need to be taken long term.
When should you make this up? If you know you are going to travel somewhere with bad water or unfamiliar biota, make it up before you leave. When you are suffering from intense diarrhea and dizziness, you are unlikely to have the desire or presence of mind to look at your herb cabinet. So be prepared.