Why Does Long-Standing Diarrhea Drain Your Energy Too?

"Doesn't diarrhea go away in a few days? But I've had it for months."

People who come in with long-standing diarrhea usually do not talk only about the diarrhea. They say they have no energy, their hands and feet are cold, they get exhausted after walking even a little, and they have lost weight. They have been told the tests show nothing seriously wrong.

When I see these patients, I do not view the diarrhea as the disease. I view the diarrhea as a result.

When the gut has stopped doing its job

The gut's original job is to take in. It extracts nutrients and water from food and brings them into the body.

But the intestinal mucosa has another job as well. It is the largest immune organ in the body. Since it is a place where countless unfamiliar substances enter every day, it must also do the work of guarding.

The problem is that these two jobs are hard to do well at the same time.

When the gut's immunity stays excited for a long time, the gut puts off the job of taking in. It shifts its direction toward flushing out what is dangerous. Instead of absorbing water, it releases it; the seams of the wall loosen; and the things it should be holding on to leak out.

Diarrhea is not the gut being broken — it is the gut giving up absorption and choosing defense.

What happens next

If it stopped here, you would have diarrhea for a few days and recover. The problem is when this state continues for a long time.

  The immunity of the intestinal mucosa stays excited for a long time
            ↓
  It stops absorbing and starts releasing   ← up to here is 'diarrhea'
            ↓
  Nutrients, water, and electrolytes keep leaking out
            ↓
  The material for making energy runs short   ← no energy
            ↓
  The body takes care of the important places first
  (protecting the heart and brain, leaving the hands and feet for later)  ← cold hands and feet
            ↓
  The adrenal glands are worn down from holding on   ← can't get up in the morning

This sequence matters. Cold hands and feet are not the cause but the fifth result.

Yet many people think here, "My body is cold, so I should eat warm things." And they seek out and eat things that warm the body. It is not the wrong direction — but if you leave the thing that collapsed at the very top untouched, everything below it collapses again.

So there is an order to treatment

I approach these patients in a strict order.

First, I calm the gut's excited immunity.
As long as the gut stays on guard, absorption will not return. The gut must feel safe first.

Second, I revive absorption.
Once the immunity settles, the gut begins to take in again. From this point, what you eat stays in the body.

Third, I support energy metabolism.
Material has to come in for energy to be made. Skip the order, and no matter how good the thing you put in, it leaks out.

Fourth, only then, peripheral circulation.
Warm hands and feet come last. The center must recover before the body has the room to send blood all the way to the fingertips.

I do not try to fix cold hands and feet first. That is a reasonable judgment the body has made. A body that sends blood to the fingertips while the center is in peril is actually the more dangerous one.

The language of pressure barely appears here

Those who have long read my writing will have seen me explain the body in terms of pressure. Yet in this illness, the talk of pressure hardly comes up.

I think this is important. The moment you try to explain every illness with a single language, you lose the ability to see the illness.

The axes that make up the body's environment are many. Physical force, time, chemistry, metabolism, immunity, nerves, circulation, hormones. In each illness, a different axis collapses first. In this illness, what collapsed first were immunity and absorption. Pressure has almost nothing to do with it.

Reading which axis collapsed first — that is what clinical practice is.

What I fear in long-standing diarrhea

There is something I must say. Long-standing diarrhea may not end as a problem of the gut alone.

When water keeps leaking out, the volume of blood circulating in the body decreases. Then the blood entering the kidneys decreases. The kidneys are an organ sensitive to blood volume. If, on top of this, substances made by the excited immunity in the gut catch on the kidneys, a burden can accumulate there.

That is why I recommend a urinalysis and a kidney function test to patients with long-standing diarrhea. These are things to confirm before using herbal medicine.

Cases where you must go to a hospital first

In the following cases, go not to a Korean medicine clinic but to a hospital first. This is non-negotiable.

• The diarrhea contains blood or is black
• The diarrhea continues with a fever
• You wake from sleep because of diarrhea at night
• You have lost weight markedly
• Your urine has noticeably decreased or turned dark
• You feel dizzy and your vision goes dark when you stand up

There are illnesses that must be ruled out first — inflammatory bowel disease, infection, tumor. Using herbal medicine before ruling these out is dangerous.

In particular, if you carelessly warm the body or strongly push circulation while it has lost a lot of water, the body may not be able to withstand it. It is like hastily flooding a dry field — the soil gets washed away.

What I honestly leave open

The order I have described so far — immunity, absorption, metabolism, circulation — is the framework that best explains what I have observed in clinical practice.

That absorption falls when the immunity of the intestinal mucosa is excited, and that energy metabolism wavers when absorption collapses, is well-known physiology. However, how much of which link in this chain herbal medicine reverses has not yet been sufficiently established in humans. Most of it is laboratory and animal research.

I have seen people helped by this framework. But I will not speak of it as though it were an established fact. Distinguishing between what herbal medicine can and cannot help — that is the line I try to keep.

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There is something people who have had long-standing diarrhea often say in the consultation room.

"I thought the lack of energy was just my age."

It may not be. It may be that your body is not taking things in. If so, there is a place to turn it back around.