Also indexed as: Stools (Loose)
Any attack of frequent, watery stools is called diarrhea. It can be
triggered by many different conditions.
Acute diarrhea is often caused by an infection and may require
medical management. The primary role of nutrition in acute diarrhea is
to prevent depletion of fluid, sodium, potassium, and calories.
Replenishment of all four has been achieved with “rehydration solutions”
and with a variety of foods, from salted
soup to peeled scraped apple to rice gruel. However, the need
for rehydration requires direct medical supervision. Therefore,
nutritional approaches to overcoming depletion of fluid, sodium,
potassium, and calories are not discussed here, but rather should be
discussed with a doctor. Diarrhea-induced low blood sugar, dehydration,
or electrolyte imbalance can be serious or even life-threatening,
particularly if prolonged in children.
A healthcare provider should be consulted if diarrhea continues for
more than a few days, as it may indicate a more serious health
condition. Diarrhea alternating with constipation may be a sign of
irritable bowel syndrome (IBS).
What are the symptoms of diarrhea?
Normal bowel habits vary considerably from person to person depending on
age, diet, cultural factors, and individual physiology. However, loose
watery stools occurring three or more times in one day is generally
considered abnormal. In some instances, diarrhea may be accompanied by
cramping abdominal pain, nausea, vomiting, fever, loss of appetite, and
bloody or foul-smelling stools.
Conventional treatment options: Rest and
fluid replacement (sometimes with the use of oral rehydration solutions
such as Pedialyte®, Ceralyte®, or Infalyte®) are often recommended.
Severe diarrhea, especially in children and the elderly, may require
hospitalization for urgent fluid and electrolyte replacement to correct
dehydration. Medicines to stop diarrhea, such as loperamide (Imodium®),
(Pepto Bismol®), attapulgite (Kaopectate®), diphenoxylate (Lomotil®,
Lonox®, Motofen®), and opiates (,
paregoric) may be prescribed in some cases.
Dietary changes that may be helpful: Some
foods contain sugars that are absorbed slowly, such as fructose in fruit
juice or sorbitol in dietetic confectionery. Through a process called
osmosis, these unabsorbed sugars hold onto water in the intestines,
sometimes leading to diarrhea. 1 By reading labels, people
with chronic non-infectious diarrhea can easily avoid fruit juice,
fructose, and sorbitol to see if this eliminates the problem.
People who are lactose intolerant—meaning they lack the enzyme needed
to digest milk sugar—often develop diarrhea after consuming
or
. People
whose lactose intolerance is the cause of diarrhea will rid themselves
of the problem by avoiding milk and ice cream or in many cases by taking
, the
enzyme needed to digest lactose. Lactase is available in a variety of
forms in pharmacies (and in grocery stores in the form of
lactase-treated milk).
Large amounts of vitamin C or magnesium found in supplements can also
cause diarrhea, although the amount varies considerably from person to
person. Unlike infectious diarrhea, diarrhea caused by high amounts of
vitamin C or magnesium is not generally accompanied by other signs of
illness. The same is true when the problem comes from sorbitol or
fructose.2 In these cases, avoiding the offending supplement
or food brings rapid relief.
Drinking several cups of
per day
causes diarrhea in some people.3 People with chronic diarrhea
who drink coffee should avoid all coffee for a few days to evaluate
whether coffee is the culprit.
Allergies and food sensitivities are common triggers for diarrhea.4
For example, some infants suffer diarrhea when fed cow’s
-based formula
but improve when switched to
-based formula.5
People with chronic diarrhea not attributable to other causes should
discuss the possibility of food sensitivity with a doctor.
Some doctors recommend a diet called the BRAT diet for acute bouts of
diarrhea. BRAT stands for bananas, rice, apples and toast. These foods
are mild, well-tolerated and good sources of fiber, potassium and other
nutrients that may be helpful in diarrhea. The efficacy of this diet has
not been evaluated in clinical trials.
Nutritional supplements that may be helpful:
An organism related to brewer’s yeast, Saccharomyces boulardii
(Sb), is widely used in Europe to prevent antibiotic-induced diarrhea.
It is also available as a supplement in the United States. Animal
research with Sb shows interference with Clostridium difficile,
a common bacterial cause of diarrhea. 6 In double-blind
trials, Sb has prevented antibiotic-induced 7 and other forms
of infectious diarrhea. 8 An intake of 500 mg four times per
day has been used in some of this research. Sb has also helped tourists
prevent traveler’s diarrhea, according to double-blind research. 9
In one trial, positive results were obtained at amounts as low as
150–450 mg per day. 10 Even diarrhea caused by Crohn’s disease
has partially responded to Sb supplementation in double-blind research. 11
While not every trial shows efficacy, 12 the preponderance of
evidence clearly supports the use of Sb in people with diarrhea caused
by antibiotics or infection. Seriously ill patients should consult with
their doctor before supplementing with Sb, as rare but serious cases of
infection caused by Sb in such patients has been reported. 13
Beneficial bacteria, such as lactobacilli and bifidobacteria,
normally live in a healthy colon, where they inhibit the over-growth of
disease-causing bacteria.14 Diarrhea flushes intestinal
microorganisms out of the digestive tract, leaving the body vulnerable
to opportunistic infections. Replenishing with acidophilus and other
beneficial probiotic bacteria can help resolve the diarrhea and prevent
new infections.15 The effective amount of probiotic bacteria
depends on the strain used, as well as the concentration of viable
organisms.
The combination of bifidobacteria and Strep thermophilus
(found in certain yogurts) dramatically reduces the incidence of acute
diarrhea in hospitalized children.16 Active-culture yogurt,
milk fermented with Lactobacillus casei and other sources of
probiotic bacteria may prevent antibiotic-induced diarrhea.17
18 19
As mentioned in the dietary changes section above, if lactose
intolerance is the cause of diarrhea, supplemental use of
prior to
consuming milk or milk-containing products can be helpful.20
Cheese rarely has enough lactose to cause symptoms in lactose-intolerant
people. Lactase products are available that can be chewed while drinking
or added to
milk directly.
The malabsorption problems that develop during diarrhea can lead to
deficiencies of many vitamins and minerals.21 For this
reason, it makes sense for people with diarrhea to take a
multivitamin-mineral supplement. Two of the nutrients that may not be
absorbed efficiently as a result of diarrhea are zinc and vitamin A,
both needed to fight infections. In third world countries,
supplementation with zinc and vitamin A has led to a reduction in, or
prevention of, infectious diarrhea in children.22 Whether
such supplementation would help people in better nourished populations
remains unclear.
supplementation has been shown to alter immune function and the flora
living in the intestine, and may relieve infectious diarrhea. Three
capsules or tablets of brewer’s yeast three times per day for two weeks
was reported to improve three cases of infectious diarrhea caused by
Clostridium difficile.23 Animal research has confirmed
that brewer’s yeast helps fight this unfriendly bacterium.24
(Note that real brewer’s yeast is not identical to nutritional, or
torula, yeast and that when asking for “brewer’s yeast” in health food
stores, people are often directed toward these other products. Real
brewer’s yeast is bitter, whereas other health food store yeasts have a
more pleasant taste.)
might be
useful for certain types of infectious diarrhea. In a double-blind
trial, children with diarrhea caused by a rotavirus were treated with
immunoglobulins extracted from colostrum derived from cows immunized
with rotavirus. Compared with the placebo, colostrum extract
significantly reduced the amount of diarrhea and the amount of oral
rehydration solution required. The rotavirus was eliminated from the
stool significantly more rapidly in the colostrum group than in the
placebo group (1.5 days, vs. 2.9 days).25
In addition to a positive effect against acute rotavirus diarrhea,26
there is also evidence that specific forms of colostrum (derived from
specially immunized cows or those with confirmed presence of specific
antibodies) are effective against diarrhea caused by Cryptosporidium
parvum, Helicobacter pylori, Escherichia coli,
and Clostridium difficile.27 28 29
30 31 However, it is not known whether
commercially-available colostrum provides significant amounts of the
specific immunoglobulins that are active against these organisms.
Furthermore, unless the immunoglobulins are present in high enough
concentrations, the preparation is not likely to be effective.32
Acute diarrhea can damage the lining of the intestine. Folic acid can
help repair this damage. In one preliminary trial, supplementing with
very large amounts of folic acid (5 mg three times per day for several
days) shortened the duration of acute infectious diarrhea by 42%.33
However, a double-blind trial failed to show any positive effect with
the same level of folic acid.34 Therefore, evidence that high
levels of folic acid supplementation will help people with infectious
diarrhea remains weak.
It is known vitamin A supplements support immune function and prevent
infections. This is true, however, only under some circumstances.
Vitamin A supplementation can also increase the risk of
infections, according to the findings of a double-blind trial.35
In a study of African children between six months and five years old, a
44% reduction in the risk of severe diarrhea was seen in those children
given four 100,000–200,000 IU supplements of vitamin A (the lower amount
for those less than a year old) during an eight-month period. On further
investigation, the researchers discovered that the reduction in diarrhea
occurred only in children who were very malnourished. For children who
were not starving, vitamin A supplementation actually increased
the risk of diarrhea compared with the placebo group. The vitamin
A-supplemented children also had a 67% increased risk of
coughing and rapid breathing, and signs of further lung infection,
although this problem did not appear in children infected with the AIDS
virus. These findings should be of concern to American parents, whose
children are not usually infected with HIV or severely malnourished.
Such relatively healthy children fared poorly in the African trial in
terms of both the risk of diarrhea and the risk of continued lung
problems. Vitamin A provided no benefit to the well-nourished kids.
Therefore, it makes sense not to give vitamin A supplements to
children unless there is a special reason to do so, such as the presence
of a condition causing malabsorption (e.g., celiac disease).
Are there any side effects or interactions? Refer to the
individual supplement for information about any side effects or
interactions.
Herbs that may be helpful: The following
recommendations are for milder forms of diarrhea. For more serious cases
of diarrhea, proper medical evaluation and monitoring should occur
before taking any herbal supplements.
An extract from stem bark latex of Sangre de drago (Croton
lechleri), an herb from the Amazon basin of Peru, has demonstrated
significant anti-diarrheal activity in preliminary36 37
and double-blind trials. Double-blind research has demonstrated the
extract’s effectiveness for traveler’s diarrhea,38
non-specific diarrhea,39 and diarrhea associated with
infection and
AIDS.40 41 For traveler’s diarrhea and nonspecific
diarrhea, amounts ranging from 125 mg to 500 mg taken four times daily
for two days have proven effective. However, in one trial, only the 125
mg four times daily amount (but not higher amounts) was effective for
acute nonspecific diarrhea.42 The reasons for the failure of
higher amounts in this study is not known. Very high amounts of these
extracts (350–700 mg four times daily for seven or more days) were used
in the trials involving people with
and AIDS. Such
levels of supplementation should always be supervised by a doctor. Most
of this research on Sangre de Drago is unpublished, and much of it is
derived from manufacturers of the formula. Further double-blind trials,
published in medical journals, are needed to confirm the efficacy
reported in these studies.
Carob is rich in tannins that have an astringent or binding effect on
the mucous membranes of the intestinal tract. A double-blind trial has
suggested it may be particularly useful for young children and infants
with diarrhea.43 Some healthcare professionals recommend 15
grams of carob powder is mixed with applesauce (for flavor) when given
to children. Carob can also be used for treating adult diarrhea.
While
from dietary
or herbal sources is often useful for constipation, it may also play a
role in alleviating diarrhea. For example, 9–30 grams per day of
(an
excellent source of fiber) makes stool more solid and can help resolve
symptoms of non-infectious diarrhea.44 Alginic acid, one of
the major constituents in bladderwrack (Fucus vesiculosus), is
a type of dietary fiber and as a result may potentially help relieve
diarrhea. However, human studies have not been done on how effective
bladderwrack is for this condition.
Other astringent herbs traditionally used for diarrhea include
blackberry leaves, blackberry root bark, blueberry leaves, and red
raspberry leaves.45 Raspberry leaves are high in tannins and,
like blackberry, may relieve acute diarrhea. A close cousin of the
blueberry, bilberry, has been used traditionally in Germany for adults
and children with diarrhea.46 Only dried berries or juice
should be used—fresh berries may worsen diarrhea.
Cranesbill has been used by several of the indigenous tribes of North
America to treat diarrhea. The tannins in cranesbill likely account for
the anti-diarrheal activity47 —although there has been little
scientific research to clarify cranesbill’s constituents and actions.
In laboratory experiments, a tannin in
, known as
ellagitannin, inhibited intestinal secretion,48 which may
help resolve diarrhea. Oak is well regarded in Germany, where it is
recommended (along with plenty of electrolyte-containing fluids) to
treat mild, acute diarrhea in children.49
Due to of its supposed antimicrobial activity, goldenseal has a long
history of use for infectious diarrhea. Its major alkaloid, berberine
(also found in barberry and Oregon grape), has been shown to improve
infectious diarrhea in some double-blind trials.50 Negative
studies have generally focused on people with cholera, while positive
studies investigated viral diarrhea or diarrhea due to strains of E.
coli. These studies generally used 400–500 mg berberine one to
three times per day. Because of the low amount of berberine in most
goldenseal products, it is unclear how effective the whole root or root
extracts would be in treating diarrhea.
Chamomile may reduce intestinal cramping and ease the irritation and
inflammation associated with diarrhea, according to test tube studies.51
Chamomile is typically taken as a tea. Many doctors recommend dissolving
2–3 grams of powdered chamomile or adding 3–5 ml of a chamomile liquid
extract to hot water and drinking it three or more times per day,
between meals. Two to three teaspoons (10–15 grams) of the dried flowers
can be steeped in a cup of hot water, covered, for ten to fifteen
minutes as well.
has been
used traditionally in the Ayurvedic system for diarrhea probably due to
its anti-inflammatory and antimicrobial actions, although human studies
have not confirmed this use.
Herbs high in mucilage, such as marshmallow or slippery elm, may help
reduce the irritation to the walls of the intestinal tract that can
occur with diarrhea. A usual amount taken is 1,000 mg of marshmallow
extract, capsules, or tablets three times per day. Marshmallow may also
be taken as a tincture in the amount of 5–15 ml three times daily.
Sweet annie has been used traditionally to treat infectious diarrhea
and malaria. However, more modern studies have used the isolated
constituent artemisinin and it is unclear how effective the herb is in
managing diarrhea.
Are there any side effects or interactions? Refer to the
individual herb for information about any side effects or
interactions.
Other integrative approaches that may be helpful: Acupuncture may be
useful for the treatment of diarrhea, particularly in infants. A
preliminary study of acupuncture treatment in 1,050 cases of infantile
diarrhea found 95% were relieved with one to three treatments. 52
Similar results have been reported in other preliminary trials 53
54 and case reports. 55 56 A controlled
trial of acupuncture for the treatment of infantile diarrhea compared
scalp acupuncture or traditional body acupuncture with drug therapy,
primarily antibiotics. The cure rate for scalp and body acupuncture was
significantly higher (90% and 89%) than that of drug treatment (46%). 57
References:
1. Hyams
JS, Etienne NL, Leichtner AM, Theuer RC. Carbohydrate malabsorption
following fruit juice ingestion in young children. Pediatr
1988;82:64–8.
2. Barness
LA. Safety considerations with high ascorbic acid dosage. Ann NY
Acad Sci 1975;258:523–8 [review].
3. Babb RR.
Coffee, sugars and chronic diarrhea. Postgrad Med 1984;75:82,
86–7.
4. James JM,
Burks AW. Food-associated gastrointestinal disease. Curr Opin
Pediatr 1996;8:471–5 [review].
5. Bowie
MD, Hill ID, Mann MD. Response of severe infantile diarrhoea to soya-based
feeds. S Afr Med J 1988;73:343–5.
6.
Pothoulakis C, Kelly CP, Joshi MA, et al. Saccharomyces boulardii
inhibits Clostridium difficile toxin A binding and
enterotoxicity in rat ileum. Gastroenterology 1993;104:1108–15.
7. Surzwicz
CM, Elmer GW, Speelman P, et al. Prevention of antibiotic-associated
diarrhea by Saccharomyces boulardii: a prospective study.
Gastroenterology 1989;96:981–8.
8.
Bleichner G, Blehaut H, Mentec H, Moyse D. Saccharomyces boulardii
prevents diarrhea in critically ill tube-fed patients. A muticenter,
randomized, double-blind placebo-controlled trial. Intensive Care
Med 1997;23:517–23.
9.
Kollaritsch H, Holst H, Grobara P, Widermann G. Prevention of traveler’s
diarrhea with Saccharomyces boulardii. Results of a placebo
controlled double-blind study. Fortschr Med 1993;111:152–6 [in
German].
10.
Kirchelle A, Fruhwein N, Toburen D. Treatment of persistent diarrhea
with S. boulardii in returning travelers. Results of a prospective
study. Forstchr Med 1996;114:136–40 [in German].
11. Plein
K, Hotz J. Therapeutic effects of Saccharomyces on mild residual
symptoms in a stable phase of Crohn’s disease with special respect to
chronic diarrhea—a pilot study. Z Gastroenterol 1993;31:129–34.
12. Lewis
SJ, Potts LF, Barry RE. The lack of therapeutic effect of Saccharomyces
boulardii in the prevention of antibiotic-related diarrhoea in elderly
patients. J Infect 1998;36:171–4.
13.
Piarroux R, Millon L, Bardonnet K, et al. Are live saccharomyces yeasts
harmful to patients? Lancet 1999;353:1851–2 [letter].
14. Poupard
JA, Hussain J, Norris RF. Biology of the bifidobacteria. Bact Rev
1973;37:136–65.
15.
Saavedra J. Probiotics and infectious diarrhea. Am J Gastroenterol
2000;95:S16–8 [review].
16.
Saavedra JM, Bauman NA, Oung I, et al. Feeding of Bifidobacterium
bifidum and Streptococcus thermophilus to infants in hospital for
prevention of diarrhoea and shedding of rotavirus. Lancet
1994;344:1046–9.
17.
Colombel JF, Cortot A, Neut C, Romond C. Yogurt with Bifidobacterium
longum reduces erythromycin-induced gastrointestinal effects. Lancet
1987;2:43 [letter].
18. Pedone
CA, Bernabeu AO, Postaire ER, et al. The effect of supplementation with
milk fermented by Lactobacillus casei (strain DN-114 001) on acute
diarrhoea in children attending day care centres. Int J Clin Pract
1999;53:179–84.
19.
Saavedra J. Probiotics and infectious diarrhea. Am J Gastroenterol
2000;95:S16–8 [review].
20. Montes
RG, Perman JA. Lactose intolerance. Postgrad Med 1991;89:175–84
[review].
21. Werbach
MR. Nutritional influences on Illness, 2d ed. Tarzana, CA:
Third Line Press, 1993, 256–61 [review].
22. Bhan
MK, Bhandari N. The role of zinc and vitamin A in persistent diarrhea
among infants and young children. J Pediatr Gastroenterol Nutr
1998;26:446–53 [review].
23.
Schellenberg D, Bonington A, Champion C, et al. Treatment of Clostridium
difficile diarrhea with brewer’s yeast. Lancet 1994;343:171–2
[letter].
24. Izadnia
F, Wong CT, Kocoshis SA. Brewer’s yeast and Saccharomyces boulardii both
attenuate Clostridium difficile-induced colonic secretion in the rat.
Dig Dis Sci 1998;43:2055–60.
25. Sarker
SA, Casswall TH, Mahalanabis D, et al. Successful treatment of rotavirus
diarrhea in children with immunoglobulin from immunized bovine colostrum.
Pediatr Infect Dis J 1998;17:1149–54.
26. Mitra
AK, Mahalanabis D, Ashraf H, et al. Hyperimmune cow colostrum reduces
diarrhoea due to rotavirus: a double- blind, controlled clinical trial.
Acta Paediatr 1995;84:996–1001.
27.
Okhuysen PC, Chappell CL, Crabb J, et al. Prophylactic effect of bovine
anti-Cryptosporidium hyperimmune colostrum immunoglobulin in healthy
volunteers challenged with Cryptosporidium parvum. Clin Infect Dis
1998;26:1324–9.
28.
Greenberg PD, Cello JP. Treatment of severe diarrhea caused by
Cryptosporidium parvum with oral bovine immunoglobulin concentrate in
patients with AIDS. J Acquir Immune Defic Syndr Hum Retrovirol
1996;13:348–54.
29.
Casswall TH, Sarker SA, Albert MJ, et al. Treatment of Helicobacter
pylori infection in infants in rural Bangladesh with oral
immunoglobulins from hyperimmune bovine colostrum. Aliment Pharmacol
Ther 1998;12:563–8.
30.
Huppertz HI, Rutkowski S, Busch DH, et al. Bovine colostrum ameliorates
diarrhea in infection with diarrheagenic Escherichia coli, shiga
toxin-producing E. Coli, and E. coli expressing intimin and hemolysin.
J Pediatr Gastroenterol Nutr 1999;29:452–6.
31. Warny
M, Fatimi A, Bostwick EF, et al. Bovine immunoglobulin
concentrate-clostridium difficile retains C difficile toxin neutralising
activity after passage through the human stomach and small intestine.
Gut 1999;44:212–7.
32. Brines
RD, Brock JH. The effect of trypsin and chymotrypsin on the in vitro
antimicrobial and iron-binding properties of lactoferrin in human milk
and bovine colostrum. Unusual resistance of human apolactoferrin to
proteolytic digestion. Biochim Biophys Acta 1983;759:229–35.
33.
Haffejee IE. Effect of oral folate on duration of acute infantile
diarrhoea. Lancet 1988;2:334–5 [letter].
34. Ashraf
H, Rahman MM, Fuchs GJ, Mahalanabis D. Folic acid in the treatment of
acute watery diarrhoea in children: a double-blind, randomized,
controlled trial. Acta Pædiatr 1998;87:1113–5.
35. Fawzi
WW, Mbise R, Spiegelman D, et al. Vitamin A supplements and diarrheal
and respiratory tract infections among children in Dar es Salaam,
Tanzania. J Pediatr 2000;137:660–7.
36. Koch J,
Tuveson J, Carlson T, Schmidt J. SB-300: a new and effective therapy for
HIV-associated diarrhea. Poster presented at the Seventh European
Conference on Clinical Aspects and Treatment of HIV-Infection, Lisbon,
Portugal, October 23–27, 1999.
37. DuPont
HL, Tidmarsh G. An open label pilot study to investigate the safety and
effectiveness of orally administered Provir (SP-303) capsules in the
symptomatic treatment of acute nonspecific diarrhea and traveler’s
diarrhea. South San Francisco, CA: Shaman Pharmaceuticals, 1998,
unpublished.
38.
Dicesare D, DuPont HL, Mathewson JJ, et al. A double-blind, randomized,
placebo-controlled study of SP-303 in the symptomatic treatment of acute
diarrhea among travelers to Mexico and Jamaica. Abstract presented at
the Infectious Diseases Society of America, 36th Annual Meeting, Denver,
CO, November 10, 1998.
39.
Ettedgui G, Schael IP, Porter S, Pennington J. A double-blind,
randomized, placebo-controlled, multi-dose, phase II study to assess the
safety and efficacy of SP-303 in the symptomatic treatment of acute
diarrhea among adult residents of Venezuela: oral administration of 125
mg, 250 mg, or 500 mg of SP-303 given every 6 hours for 48 hours. South
San Francisco, CA: Shaman Pharmaceuticals, 1998, unpublished.
40.
Holodniy M, Koch J, Mistal M, et al. A double blind, randomized,
placebo-controlled phase II study to assess the safety and efficacy of
orally administered SP-303 for the symptomatic treatment of diarrhea in
patients with AIDS. Am J Gastroenterol 1999;94:3267–73.
41. Koch J.
A phase III, double-blind, randomized, placebo-controlled multi-center
study of SP-303 (Provir™) in the symptomatic treatment of diarrhea in
patients with acquired immunodeficiency syndrome (AIDS). Posters
presented at the 13th international AIDS Conference in Durba, South
Africa, July 14, 2000.
42.
Ettedgui G, Schael IP, Porter S, Pennington J. A double-blind,
randomized, placebo-controlled, multi-dose, phase II study to assess the
safety and efficacy of SP-303 in the symptomatic treatment of acute
diarrhea among adult residents of Venezuela: oral administration of 125
mg, 250 mg, or 500 mg of SP-303 given every 6 hours for 48 hours. South
San Francisco, CA: Shaman Pharmaceuticals, 1998, unpublished.
43. Loeb H,
Vandenplas Y, Wursch P, Guesry P. Tannin-rich pod for treatment of
acute-onset diarrhea. J Pediatr Gastroenterol Nutr
1989;8:480–5.
44. Eherer
AH, Porter J, Fordtran JS. Effect of psyllium, calcium polycarbophil,
and wheat bran on secretory diarrhea induced by phenolphthalein.
Gastroenterol 1993;104:1007–12.
45. Tyler
VE. Herbs of Choice: The Therapeutic Use of Phytomedicinals.
New York: Pharmaceutical Products Press, 1994, 51–4.
46. Weiss
RF. Herbal Medicine. Gothenburg, Sweden: Ab Arcanum and
Beaconsfield, UK: Beaconsfield Publishers Ltd, 1988, 101–2.
47. Duke
JA. CRC Handbook of Medicinal Plants. Boca Raton, FL: CRC
Press, 1985, 209.
48. Konig
M, Scholz E, Hartmann R, et al. Ellagitannins and complex tannins from
Quercus petraea bark. J Nat Prod 1994;57:1411–5.
49.
Schilcher H. Phytotherapy in Paediatrics. Stuttgart, Germany:
Medpharm Scientific Publishers, 1997, 49–50.
50.
Khin-Maung-U, Myo-Khin, Nyunt-Nyunt-Wai, et al. Clinical trial of
berberine in acute watery diarrhoea. Br Med J 1985;291:1601–5.
51.
Achterrath-Tuckerman U, Kunde R, et al. Pharmacological investigations
with compounds of chamomile. V. Investigations on the spasmolytic effect
of compounds of chamomile and Kamillosan® on isolated guinea pig ileum.
Planta Med 1980;39:38–50.
52. Su Z.
Acupuncture treatment of infantile diarrhea: a report of 1050 cases.
J Tradit Chin Med 1992;12:120–1.
53. Feng WL.
Acupuncture treatment for 30 cases of infantile chronic diarrhea. J
Tradit Chin Med 1989;9:106–7.
54. Lin YC.
Observation of therapeutic effects of acupuncture treatment in 170 cases
of infantile diarrhea. J Tradit Chin Med 1987;7:203–4.
55. Cao Y.
Personal experience on acupuncture treatment of diarrhea. J Tradit
Chin Med 1990;10:163–7.
56. Cao Y.
Personal experience on acupuncture treatment of diarrhea. J Tradit
Chin Med 1990;10:251–6.
57. Lin Y,
Zhou Z, Shen W, et al. Clinical and experimental studies on shallow
needling technique for treating childhood diarrhea. J Tradit Chin
Med 1993;13:107–14.
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