April's wind carries dampness, and the continuous spring rain makes the air feel as if it could be wrung out. Have you noticed that many friends around you are complaining about the same thing this season—when going to the bathroom, the first few stools are dry and hard, like small stones, difficult to pass; yet the ones that follow gradually become softer, and by the end, they are even loose and formless? Is this constipation, or diarrhea? Should you adjust in one direction or the other? Today, let us examine this issue thoroughly from the perspective of classical Chinese medicine.
I. Spleen Deficiency and Dampness Stagnation: Two Gourds on the Same Vine
"When the Middle Qi is insufficient, urination and defecation will change accordingly." — *Huangdi Neijing · Lingshu · Kou Wen Pian*, Chapter 28
Translated literally, this means: once the Middle Qi is insufficient, both urine and stool will "change their appearance." Middle Qi refers to the qi of the spleen and stomach, which Chinese medicine calls the "root of acquired constitution." It functions like the body's logistics center, responsible for sorting ingested food—sending the useful refined substances upward to nourish the whole body, and passing the useless waste downward to form stool. When this logistics center lacks power, its sorting speed cannot keep up.
In plain terms, the longer food residue lingers in the large intestine, the more water is absorbed, and the drier and harder the stool becomes. The first few lumps are precisely the "backlogged inventory"—they have spent the longest time in the intestinal tract, and with water repeatedly absorbed, they naturally become as hard as stone. Meanwhile, as new material continuously comes down the line, the intestines have no time to fully absorb the water, and with spleen deficiency impairing transportation and transformation, dampness descends along with it, creating the pattern of "hard at first, loose later." In modern clinical practice, this bowel pattern is especially common among office workers with irregular diets, prolonged sitting, and excessive mental rumination, often accompanied by bloating after meals, heavy lethargy upon waking, and tooth-marked tongue edges.
What we have discussed above identifies spleen deficiency as the root cause, but do not forget the "accomplice" of dampness stagnation. Zhang Jingyue, a Ming dynasty physician, used an analogy in *Jingyue Quanshu*: "Water turns counterflow into dampness; grain turns counterflow into stagnation." This means that when the spleen and stomach lose their transporting and transforming power, the water one drinks forms internal dampness, and the food one eats becomes accumulation and stagnation. Dampness is heavy, turbid, sticky, and greasy; it most easily traps the spleen and stomach, making the transporting function even worse. This creates a closed loop: spleen deficiency generates dampness, dampness in turn traps the spleen, transformation weakens further, and the stool becomes even more unruly.
From the perspective of pathogenesis, this process involves three levels: the cause begins with diet, overwork, and injury to the spleen; the location is mainly the middle jiao (spleen and stomach) and the large intestine; and the nature is one of mixed deficiency and excess—deficiency lies in spleen qi, excess lies in dampness stagnation. In terms of disease course, if left unaddressed, it tends to progress from occasional episodes to frequent occurrences. Clinically, one can see both the pure pattern of spleen deficiency with exuberant dampness, and the pattern of spleen deficiency complicated by intestinal fluid insufficiency. In the latter, the hardness of the initial stool segment is more pronounced, often accompanied by dry mouth with no desire to drink, and dry skin. The two patterns differ in treatment focus: the former emphasizes strengthening the spleen and resolving dampness, while the latter requires both moistening the intestines and activating the spleen.
II. Warming Kidney Yang and Soothing Liver Qi: Two Overlooked Keys
"The kidneys govern the two excretions." — *Huangdi Neijing · Suwen · Jinkui Zhenyan Lun Pian*, Chapter 4
Many people fix their eyes only on the spleen and stomach, forgetting the kidney—the "master switch." In Chinese medical theory, the kidney governs water and manages the two excretions—urination and defecation. The driving force behind bowel movements is ultimately rooted in the warming and propelling action of kidney yang. Kidney yang is like a fire within the body. When this fire is vigorous, intestinal peristalsis is powerful and water metabolism flows smoothly. If kidney yang is insufficient, this fire turns into a "low flame": intestinal peristalsis becomes weak and feeble, and water distribution goes awry—the upper body feels dry while the lower body is flooded with dampness.
You see, stool that is hard at first and loose later is precisely a typical manifestation of uneven water distribution. It is like a heating system that develops a problem: the distant rooms are cold and shivering, while the nearby rooms are hot and sweating. When kidney yang is insufficient, the "heating" at the terminal end of the large intestine cannot keep up, and the water in the waste is not vaporized and utilized in time, causing the front segment to be dry and hard. Meanwhile, the water in the small intestine is not adequately reabsorbed and rushes en masse into the large intestine, resulting in loose stool in the later segment. Clinically, in addition to the pattern of hard-then-loose stools, such individuals often also experience cold and soreness in the lower back and knees, frequent nocturia, cold hands and feet, and low spirits.
"The earth achieves its function when it receives the wood." — *Huangdi Neijing · Suwen · Baoming Quanxing Lun Pian*, Chapter 25
This "earth" refers to the spleen and stomach; "wood" refers to the liver. In the five-phase restraining cycle, wood controls earth. Normal restraint is a good thing—the free flow of liver qi assists the spleen and stomach in transportation and transformation, just as a farmer first loosens the soil with a plow before planting. But when emotions are frustrated or stress is excessive, liver qi becomes constrained, and this restraining force turns into "oppression," leaving the spleen and stomach immobilized.
Clinically, many people with hard-then-loose stools share a common trait: when work stress rises, their bowel problems noticeably worsen; when the weekend comes and they relax, their stools become much smoother. This is no coincidence—it is disharmony between the liver and spleen at work. Liver qi constraint not only affects spleen and stomach transportation, but also interferes with the large intestine's transmission function. The dry, hard front segment of the stool carries the shadow of liver qi stagnation and failure of the intestines to discharge freely; the loose, watery back segment is the result of liver wood attacking the spleen and damaging spleen qi. Such individuals are often accompanied by abdominal distension, frequent belching, wide mood swings, and breast distension before menstruation.
III. Practical Everyday Changes Guided by the Classics
"When one eats and drinks to excess, the stomach and intestines are injured." — *Huangdi Neijing · Suwen · Bi Lun Pian*, Chapter 43
The classics have long warned us: when you eat too much or too richly, the stomach and intestines are the first to suffer. Many people with hard-then-loose stools will, upon reflecting on their recent diet, find clues—more business banquets, accepting every rich and fatty delicacy, drinking milk tea and coffee like water, ordering heavy takeout for dinner with excessive oil and salt until stuffed. All of this invisibly burdens the spleen and stomach.
From the perspective of Chinese medicine health preservation, daily care can begin with "lightening the load on the spleen and stomach." In terms of diet, try adjusting your three meals to seven or eight-tenths full, and chew slowly and thoroughly so that saliva mixes fully with food. Eat fewer raw, cold fruits and greasy, rich foods, and appropriately increase the intake of spleen-fortifying and qi-supplementing ingredients such as Chinese yam, lotus seed, Poria cocos, and Gordon euryale seed. These medicinal-and-edible items are excellent companions in soups and porridge. In terms of daily routine, try to fall asleep before 11 p.m. to give kidney yang time to "recharge"; drink a glass of warm water on an empty stomach in the morning to help awaken the intestines. In terms of emotions, do not let frustration stagnate in your heart—take walks, listen to music, or chat with friends to "untie" the liver qi. As for exercise, gentle practices such as Baduanjin and tai chi can benefit spleen and stomach transportation and transformation; the key is long-term persistence, not starting and stopping after a few days.
Restoring the transporting and transforming function of the spleen and stomach is not a one-day affair. It is like growing a flower in a pot: watering it today and fertilizing it tomorrow, expecting it to bloom the day after, is unrealistic; but if you tend it daily with care, the flower will eventually bloom. When the stool gradually changes from "hard at first and loose later" to well-formed and soft, treat this change as the body telling you: the Middle Qi is recovering, the water is returning to its proper place, and that warm "flame" has been stabilized.
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Have you ever thought that "hard at first, loose later" might not simply be the intestine's temper? It is more like the body using a special way to remind you: the spleen earth needs loosening, the kidney fire needs replenishing, and the liver wood needs smoothing. The next time you finish in the bathroom, take another look—that is not merely metabolic waste, but a letter sent through the spleen and stomach on someone's behalf.
References:
1. The original texts of *Huangdi Neijing · Suwen* and *Huangdi Neijing · Lingshu* can be consulted in the TCM 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/
Related Q&A
I. What causes spleen deficiency and dampness stagnation?
In Chinese medicine, the causes of spleen deficiency and dampness stagnation must be analyzed through holistic pattern differentiation, using the four diagnostic methods—inspection, auscultation/olfaction, inquiry, and palpation—combined with individual constitution characteristics for a comprehensive judgment. It cannot be generalized. The specific direction of treatment should be determined by a licensed TCM practitioner after an in-person consultation.
II. How long is the treatment cycle for warming kidney yang and soothing liver qi?
The treatment cycle varies from person to person and is related to factors such as individual constitution and compliance with lifestyle adjustments. Chinese medicine emphasizes gradual progress. The specific cycle needs to be assessed by a licensed TCM practitioner after an in-person consultation; this material does not provide any specific cycle commitment.
III. What should be noted in daily care under the guidance of the classics?
In terms of daily care, it is recommended to maintain a regular routine, a balanced diet, moderate exercise, and emotional stability. Specific precautions should be flexibly adjusted according to individual constitution and seasonal changes. You may consult a licensed TCM practitioner for targeted advice.