Nervous Diarrhea? The Old Saying "When Anxious, First Run to the Latrine" Hides a Centuries-Old Feud Between Liver and Spleen

When I was a child, I often heard the elders mutter: "A person lives by a breath of qi, a tree lives by a layer of bark; when anxious, one first runs to the latrine, and even immortals would sigh." At the time, I took it as a joke. It was only after studying medicine that I began to savor its meaning—the phenomenon of "rushing to the latrine when anxious" had long been noticed by the older generation, though they could not explain why. In Chinese medicine theory, that breath of qi is precisely liver qi; and the urgency to run to the latrine is the spleen and stomach "going on strike." When the two meet, the drama unfolds.

I. "Anger Makes Qi Rise Reversely; in Severe Cases, It Causes Sun Xie"—The "Tug-of-War" Between Liver and Spleen

"Anger makes qi rise reversely; in severe cases, it causes vomiting of blood and sun xie." — Huangdi Neijing · Suwen · Ju Tong Lun, Chapter 39

This classic passage literally means that under intense anger, qi mechanism rushes upward, and in severe cases, it may cause vomiting of blood or diarrhea with undigested food. The term "sun xie" precisely depicts that condition of sudden cramping abdominal pain, rushing to the toilet without a second thought, and even passing undigested food in the stool. Over two thousand years ago, the Neijing had already clearly described the pathway by which emotions trigger diarrhea, showing that this is not a "modern fashionable illness" but an unchanging physiological law.

In plain terms: Liver qi is like an impetuous general, governing the free flow and smooth movement of qi throughout the body. The spleen and stomach are like a busy granary, responsible for receiving, decomposing, and transporting food and water. Normally, each performs its own duties—one issues orders, the other executes them. When tension, anxiety, or anger arises, liver qi becomes like a runaway horse, charging recklessly and directly "overacting" on the territory of the spleen and stomach. Caught off guard by this sudden rush, the transport and transformation functions immediately become disordered—what should be absorbed cannot be absorbed in time, what should be transmitted cannot be transmitted in time, and food and water mix and move downward, turning into urgent diarrhea.

Clinically, diarrhea triggered by nervousness is most commonly seen in individuals with liver qi stagnation and spleen deficiency, or liver excess and spleen weakness. Such people often tend to overthink, or have long been under high-pressure work environments. They are not prone to showing emotions and habitually "bottle up" anxiety inside. The body is like a tightly drawn bowstring; when critical moments such as exams, interviews, or public presentations arrive, the string suddenly vibrates more intensely, and the spleen and stomach are the "conductor" that feels the tremor first.

From the four dimensions of etiology, location, nature, and trend, the "etiology" of this type of diarrhea is led by emotional dysregulation, possibly accompanied by irregular diet or excessive fatigue; the "location" is in the liver and spleen, closely related to intestinal qi mechanism disorder; the "nature" is root deficiency with branch excess—spleen deficiency as the root, qi stagnation as the branch; and the "trend" fluctuates with emotional changes, worsening under tension and easing with relaxation. This is the key feature that distinguishes it from other types of diarrhea.

II. Even for the Same Tension-Type Diarrhea, Different Constitutions Call for Different Approaches

Clinically, it is necessary to first distinguish whether "liver qi excess" or "spleen qi deficiency" predominates, as the treatment directions differ. To use an analogy: the former is like a grumpy cat that knocks over the dinner table—the key is to soothe the cat's mood; the latter is like a wobbly table that falls apart at the slightest wind—the key is to secure the table legs.

For those with predominant liver qi excess, common manifestations include obvious abdominal cramping during tension, relief of pain after diarrhea, a tendency toward dry mouth and bitter taste, distension in both hypochondriac regions, shallow sleep with many dreams, a tongue that tends to be red, and a wiry pulse. The "tension" in such individuals is often accompanied by a strong sense of confrontation; inside the body, it is as if an invisible fire is burning, disturbing the movement of fluids in the intestines. From the perspective of pathogenesis, this is a typical pattern of "liver wood overacting on spleen earth," where qi stagnation transforms into fire and drives downward to the intestines.

For those with predominant spleen qi deficiency, the more common manifestations are borborygmus and loose, unformed stools during tension, with a tendency toward fatigue, bloating after meals, sallow complexion, weakness in the limbs, tooth-marked tongue edges, and a weak pulse. The foundation of the spleen and stomach in such individuals is inherently fragile, like a boat with limited carrying capacity; at the slightest emotional fluctuation, water splashes in and the boat rocks. The key pathogenesis lies in "spleen deficiency with loss of transportation," while liver qi merely acts as the wind that capsizes the boat.

Someone once asked whether all tension-type diarrhea belongs to liver-spleen disharmony. Not necessarily. Clinically, if some individuals also present with soreness and weakness of the lower back and knees, aversion to cold with cold extremities, and dawn diarrhea, it may belong to spleen-kidney yang deficiency with decline of mingmen fire, and treatment should not simply proceed from soothing the liver. A small number of people who experience diarrhea during tension along with palpitations, insomnia, and poor memory should be examined from the perspective of heart-spleen dual deficiency, and the focus of care differs accordingly. This is precisely the subtlety of Chinese medicine's "same disease, different treatments"—the same symptom may stem from entirely different patterns of imbalance.

III. Four Dimensions of Daily Care: The Wisdom of "Unbinding" the Liver and Spleen

Knowing the pathogenesis does not mean rushing to find a prescription. Chinese medicine health preservation emphasizes "three parts treatment, seven parts nurturing." Daily habits often matter more than last-minute remedies. The following directions are for reference for those who wish to regulate their health in ordinary times; specific plans should be determined by a licensed Chinese medicine practitioner based on individual constitution.

Dietary dos and don'ts—the key word is "gentle." For those with tension-type diarrhea, the diet should favor easily digestible, warming foods such as Chinese yam, millet, and white hyacinth bean. Cooking methods should focus on steaming, boiling, and stewing, avoiding raw, cold, greasy, spicy, or irritating foods. Eat slowly and chew thoroughly, giving the spleen and stomach ample time to "take over" the food. As the saying goes, "When grain enters the stomach, stomach qi rises to the lungs." When the spleen and stomach are harmonious, the qi mechanism operates in an orderly manner. It should be noted that dietary adjustment is a part of long-term nurturing, not a measure for gradual improvement [note: original text says "gradual improvement" but context likely means "immediate improvement"; I will translate as "step-by-step improvement" as written].

Daily routine—the key word is "regularity." Staying up late most harms liver blood; when liver blood is insufficient, liver qi tends to stagnate. Going to bed at a fixed time and waking at a fixed time gives the body a stable rhythmic signal. A short nap at noon, even just closing the eyes and resting for a dozen minutes, helps with liver qi's free flow and the spleen and stomach's recuperation. People with long-term irregular schedules often experience more pronounced emotional fluctuations, which mutually reinforce the rhythm disorders of the liver and spleen.

Emotional regulation—the key word is "awareness." When tension arrives, one can first take several deep breaths, shifting attention from "what is about to happen" back to "the physical sensations of the present moment." This feeling is like standing by a river watching the water flow, letting thoughts drift by without grasping them. When a person becomes aware of their emotions rather than being carried away by them, liver qi gains room to maneuver. Traditional Chinese medicine theory points out that the liver governs free flow, delights in orderly reach, and detests depression. Finding one's own emotional outlet—keeping a journal, taking a walk, talking with a trusted friend—are all ways to "let liver qi out for air."

Exercise and guided movements—the key word is "gentle and slow." Gentle exercises such as brisk walking, Baduanjin, and tai chi help promote the flow of qi and blood, and are especially suitable for those with liver stagnation and spleen deficiency. During exercise, breathing should be natural and deep, allowing the diaphragm to move up and down and provide a gentle "massage" to the spleen and stomach. This aligns with the Chinese medicine principle that "when qi moves, water moves." The intensity of exercise should be such that one sweats slightly; there is no need to pursue profuse sweating, as excessive sweating can consume qi and damage fluids. It should be noted that exercise and guided movement are one of the daily care methods. For those with obvious symptoms, it is recommended to consult a licensed Chinese medicine practitioner at a regular medical institution.

In the end, experiencing diarrhea whenever nervous is the body's most direct way of telling you: between the liver and the spleen, there is an emotional debt that has not yet been settled. It reminds you that perhaps it is time to find an outlet for your stress and leave some composure for your spleen and stomach. The next time tension strikes, pay attention—do you first feel your stomach tightening, or do you first hear your intestines gurgling? Observing the signals your body sends is itself the beginning of regulation.

References:

1. The original text of Huangdi Neijing · Suwen can be consulted in the Traditional Chinese Medicine Ancient Literature Database: https://tcmdata.cintcm.com/

2. WHO strategy document on traditional medicine: https://www.who.int/health-topics/traditional-complementary-and-integrative-medicine

3. Official website of the National Administration of Traditional Chinese Medicine: https://www.satcm.gov.cn/

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