DEFECATION

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Chapter 72

DEFECATION

Chapter contents

DIARRHOEA OR LOOSE STOOLS

Interrogation, Chapter 31

DIARRHOEA WITH VOMITING

Food poisoning

Violent diarrhoea and vomiting with sudden onset, nausea at the smell of food, epigastric fullness, sour regurgitation, thick tongue coating, Slippery pulse.

Cold-Dampness in the Stomach and Intestines

Diarrhoea without smell, and vomiting, mucus in the stools, abdominal pain that is alleviated by application of heat, epigastric and abdominal fullness, a feeling of heaviness of the head and body, a feeling of cold, cold limbs, sticky white tongue coating, Slippery-Slow pulse.

Stomach and Intestines deficient and cold

Diarrhoea and vomiting of watery fluids, dull abdominal pain, discomfort or dull pain in the epigastrium, better after eating and with pressure or massage, no appetite, preference for warm drinks and foods, vomiting of clear fluid, absence of thirst, cold and weak limbs, tiredness, pale complexion, Pale and wet tongue, Deep-Weak-Slow pulse.

Retention of food

Diarrhoea with vomiting, fullness, pain and distension of the epigastrium which are relieved by vomiting, nausea, vomiting of sour fluids, foul breath, sour regurgitation, belching, insomnia, loose stools or constipation, poor appetite, thick tongue coating, Full-Slippery pulse.

Invasion of Summer-Heat

Sudden diarrhoea and vomiting, epigastric pain, sour regurgitation, aversion to cold, fever, thirst, irritability, a feeling of oppression of the chest, headache, cold hands and feet, dark urine, Floating-Rapid pulse.

CONSTIPATION

Interrogation, Chapter 31

The term ‘constipation’ is used to describe the slow movement of unduly firm contents through the large bowel leading to infrequent passing of small hard stools. Thus, constipation may indicate several different symptoms, among which are:

• bowel movements which do not occur daily

• dry stools

• difficult defecation

• abnormal shape of stools.

Views on what constitutes a normal frequency of bowel movement vary widely. From the point of view of Chinese medicine the bowel movement should occur at least once a day. This view runs counter to the Western medical view, according to which the frequency of bowel movement is not that important so long so they occur regularly.

Heat in the Intestines

Constipation with dry stools, burning sensation in the mouth, dry tongue, burning and swelling in anus, scanty dark urine, thick, dry yellow (or brown or black) tongue coating, Full-Rapid pulse.

Liver-Fire

Constipation with dry stools, headaches, dizziness, tinnitus, irritability, propensity to outbursts of anger, red face, thirst, bitter taste, dark urine, Red tongue with redder sides and dry yellow coating, Wiry-Rapid pulse.

Heat in Bright Yang (organ syndrome)

Constipation with dry stools, abdominal pain and fullness, fever, burning epigastric pain, intense thirst with a desire to drink cold liquids, mental restlessness, dry mouth, mouth ulcers, bleeding gums, sour regurgitation, foul breath, nausea, vomiting soon after eating, a feeling of heat, tongue Red with a thick, dry dark-yellow coating, Deep-Full-Rapid pulse.

This corresponds either to the organ pattern of Heat in Bright Yang within the identification of patterns according to the Six Stages or to the pattern of Dry-Heat in the Intestines within the identification of patterns according to the Four Levels.

Liver-Qi stagnation

Constipation with small stools, or alternation of constipation with diarrhoea, difficulty in defecation, hypochondrial or epigastric distension, irritability, moodiness, a feeling of a lump in the throat, premenstrual tension, Wiry pulse.

Kidney-Yang deficiency

Chronic constipation, exhaustion after bowel movement, stools not dry, lower backache, cold knees, a feeling of cold, bright-white complexion, weak knees, tiredness, lassitude, abundant clear urination, urination at night, impotence, decreased libido, Pale and wet tongue, Deep-Weak pulse.

Blood deficiency

Dry stools, difficulty in defecation, dizziness, blurred vision, floaters, numbness/tingling of the limbs, scanty menstruation, dull-pale complexion, Pale tongue, Choppy or Fine pulse.

Yin deficiency of the Stomach and Intestines

Constipation, dry stools, no appetite or slight hunger but no desire to eat, dull or slightly burning epigastric pain, abdominal pain, dry mouth and throat especially in the afternoon, thirst but no desire to drink, or a desire to drink in small sips, a slight feeling of fullness after eating, normal-coloured tongue without coating, or without coating, in the centre, Floating-Empty pulse.

Kidney- and Liver-Yin deficiency

Dry stools, dizziness, tinnitus, hardness of hearing, lower backache, dull occipital or vertical headache, insomnia, numbness/tingling of the limbs, dry eyes, blurred vision, dry throat, dry hair and skin, brittle nails, night sweating, scanty menstruation or amenorrhoea, normal-coloured tongue without coating, Floating-Empty pulse.

Spleen- and Lung-Qi deficiency

Constipation with difficulty in opening the bowels with a feeling of exhaustion afterwards, thin and long stools that are not dry, poor appetite, slight abdominal distension after eating, tiredness, lassitude, pale complexion, weakness of the limbs, slight shortness of breath, slight cough, weak voice, spontaneous daytime sweating, a dislike of speaking, bright-white complexion, tendency to catch colds, tiredness, dislike of cold, Pale tongue, Empty pulse.

Cold in the Intestines

Constipation, stools not dry, absence of bowel movement for several days, spastic abdominal pain, a cold sensation in abdomen, thick white tongue coating, Deep-Wiry pulse.

Dampness in the Intestines

Constipation, a feeling of fullness and heaviness of the abdomen, abdominal pain, sticky taste, thick sticky tongue coating on the root, pulse Slippery on both Rear positions.

Retention of food in the Intestines

Constipation, abdominal pain alleviated by evacuation, a feeling of fullness of the abdomen, thick sticky tongue coating on the root, pulse that is Slippery on both rear positions.

Clinical note

• When a patient complains about ‘constipation’, always establish clearly what they are referring to (i.e. frequency of stool, consistency of it or difficulty in passing a stool).

ALTERNATION OF CONSTIPATION AND LOOSE STOOLS

Alternation of constipation and loose stools means that the patient goes through periods of constipation (by which is meant that the stools are infrequent or rather difficult and bitty) followed by a period of loose stools; these periods may last days or weeks.

Interrogation, Chapter 31

Stagnant Liver-Qi invading the Spleen

Alternation of periods of constipation and loose stools, small and bitty stools, straining on defecation during the periods of constipation, abdominal distension, abdominal pain that is not relieved by the bowel movement, hypochondrial or epigastric distension, irritability, moodiness, a feeling of a lump in the throat, premenstrual tension, tongue that may have Red sides (if Liver-Qi stagnation predominates) or Pale sides (if Spleen-Qi deficiency predominates), pulse that is Wiry on the left and Weak on the right.

Stagnant Liver-Qi invading the Spleen, Dampness

Alternation of periods of constipation and loose stools, small and bitty stools, mucus in the stools, straining on defecation during the periods of constipation, abdominal distension and fullness, abdominal pain that may be relieved by the bowel movement (if Dampness predominates), hypochondrial or epigastric distension, irritability, moodiness, a feeling of a lump in the throat, premenstrual tension, a feeling of heaviness of the abdomen, tongue that may have Red sides (if Liver-Qi stagnation predominates) or Pale sides (if Spleen-Qi deficiency predominates) with a sticky coating, pulse that is Wiry on the left and Soggy on the right.

Severe Spleen-Qi deficiency

Alternation of constipation and loose stools, no abdominal pain or fullness, poor appetite, slight abdominal distension after eating, tiredness, lassitude, pale complexion, weakness of the limbs, loose stools, Pale tongue, Empty pulse.

Clinical note

• I find nearly always that the so-called ‘irritable bowel syndrome’ characterized by alternation of constipation and loose stools is due to three pathogenic conditions in varying proportions:

—Liver-Qi stagnation

—Spleen-Qi deficiency

—Dampness.

INCONTINENCE OF FAECES

Spleen- and Kidney-Yang deficiency

Incontinence of faeces, early-morning diarrhoea, lower backache, cold and weak knees, a feeling of cold, bright-white complexion, impotence, decreased libido, tiredness, lassitude, abundant clear urination, urination at night, loose stools, poor appetite, slight abdominal distension, a desire to lie down, Pale and wet tongue, Deep-Weak pulse.

Spleen- and Lung-Qi deficiency

Incontinence of faeces, poor appetite, slight abdominal distension after eating, tiredness, pale complexion, weakness of the limbs, loose stools, slight shortness of breath, slight cough, weak voice, spontaneous daytime sweating, a dislike of speaking, tendency to catch colds, dislike of cold, Pale tongue, Empty pulse.

This pattern usually occurs only in the elderly.

BLOOD AND MUCUS IN THE STOOLS

Interrogation, Chapter 31

Damp-Heat in the Intestines

Diarrhoea with blood and mucus, a burning sensation of the anus, a feeling of heaviness, abdominal pain, a feeling of heat, Red tongue with sticky yellow coating, Slippery-Rapid pulse.

Deficiency of Yin of the Stomach and Intestines with Empty-Heat

Blood and mucus in the stools, dull abdominal pain, dull or burning epigastric pain, a feeling of heat in the afternoon, dry mouth and throat especially in the afternoon, thirst with a desire to drink in small sips, feeling of hunger but no desire to eat, night sweating, five-palm heat, bleeding gums, Red tongue (or Red centre only) without coating in the centre, Floating-Empty and Rapid pulse.

Cold-Dampness in the Intestines

Diarrhoea with a lot of mucus and a little blood, abdominal pain and fullness, nausea, vomiting, a feeling of heaviness, cold limbs, Pale tongue with sticky white coating, Slippery-Slow pulse.

Large Intestine deficient and cold

Diarrhoea with little mucus and blood, dull abdominal pain that is relieved by the application of heat, a feeling of cold, cold limbs, tiredness, Pale tongue, Deep-Weak pulse.

Toxic Heat in the Intestines

Diarrhoea with mucus and blood, foul-smelling stools, a burning sensation of the anus, fever, a feeling of heat, abdominal pain, Red tongue with red points and thick, sticky yellow coating, Overflowing-Slippery-Rapid pulse.

Clinical note

• Blood and mucus in the stools may indicate ulcerative colitis and the patient should always be referred for a colonoscopy.

MUCUS IN THE STOOLS

Interrogation, Chapter 31

Dampness in the Intestines

Mucus in the stools, loose stools, abdominal fullness/pain, a feeling of heaviness of the abdomen, a sticky taste, sticky tongue coating, Slippery pulse.

Damp-Heat in the Intestines

Mucus in the stools, loose stools with foul smell, a burning sensation of the anus, abdominal fullness and pain, a feeling of heaviness of the abdomen, a sticky taste, thirst without desire to drink, sticky yellow tongue coating, Slippery-Rapid pulse.

BLOOD IN THE STOOLS

Interrogation, Chapter 31

Chinese medicine differentiates this symptom according to the colour of the blood to identify the pattern without consideration of the site of bleeding. In this instance, however, it is important to ask the patient to obtain a Western diagnosis as well. In fact, blood in the stools can be caused by bleeding haemorrhoids or anal fissures, or by bleeding within the large intestine; obviously these two symptoms are very different in pathology and severity.

Damp-Heat in the Intestines

Fresh blood in the stools, loose stools, smelly stools, abdominal pain, a burning sensation in the anus, a feeling of heaviness, abdominal fullness, Red tongue with sticky yellow coating and red spots on the root, Slippery-Rapid pulse.

Stomach- and Spleen-Qi deficiency

Profuse fresh blood in the stools, no smell, loose stools, slight abdominal pain, poor appetite, slight abdominal distension after eating, tiredness, lassitude, pale complexion, weakness of the limbs, an uncomfortable feeling in the epigastrium, lack of taste sensation, Pale tongue, Empty pulse.

Heat in the Intestines

Dark blood in the stools, abdominal pain, constipation, a feeling of heat, thirst, Red tongue with dry yellow coating, Deep-Full-Rapid pulse.

Toxic Heat in the Intestines

Diarrhoea with mucus and blood, foul-smelling stools, a burning sensation of the anus, fever, feeling of heat, abdominal pain, Red tongue with red points and thick, sticky yellow coating, Overflowing-Slippery-Rapid pulse.

Blood stasis in the Intestines

Dark blood in the stools, abdominal pain, dark complexion, anxiety, Purple tongue, Wiry pulse.

Liver- and Kidney-Yin deficiency with Empty-Heat

Fresh blood in the stools, constipation, dizziness, tinnitus, dull occipital or vertical headache, insomnia, numbness/tingling of limbs, malar flush, dry eyes, blurred vision, lower backache, dry throat, dry hair and skin, brittle nails, dry vagina, night sweating, scanty menstruation, five-palm heat, a feeling of heat in the evening, Red tongue without coating, Floating-Empty and Rapid pulse.

DIFFICULTY IN DEFECATION

Interrogation, Chapter 31

‘Difficulty in defecation’ is a translation of the complex Chinese symptom called li ji hou zhong. This symptom is composed of two parts: li ji means that the patient has abdominal pain and the urge to defecate but is unable to; hou zhong means that the patient does defecate eventually but the abdominal discomfort is not relieved by it and there is a feeling of heaviness after defecation.

Stagnation of Qi in the Intestines

Difficulty in defecation, abdominal distension, abdominal pain before defecation not relieved after defecation, small, bitty stools, Wiry pulse.

Damp-Heat in the Intestines

Difficulty in defecation, abdominal pain relieved by defecation, burning sensation in the anus, mucus in the stools, foul-smelling stools, a feeling of heaviness, sticky yellow tongue coating, Slippery-Rapid pulse.

Spleen-Qi deficiency

Difficulty in defecation or loose stools, tiredness after defecation, slight abdominal distension, poor appetite, tiredness, pale complexion, Pale tongue, Empty pulse.

Intestines Dryness and Liver-Blood deficiency

Difficulty in defecation, dry stools, dull abdominal pain, dry skin, dizziness, blurred vision, floaters, numbness/tingling of limbs, scanty menstruation, dull-pale complexion, Pale tongue, Choppy or Fine pulse.

STRAINING IN DEFECATION

Interrogation, Chapter 31

‘Straining in defecation’ means that the patient does have a bowel movement every day but the movement takes a long time and involves straining. ‘Straining in defecation’ differs from ‘constipation’ in three respects:

1. With ‘straining in defecation’, unlike ‘constipation’, there is a bowel movement every day

2. With ‘straining in defecation’, unlike ‘constipation’ the stools are not dry

3. With ‘straining in defecation’, unlike ‘constipation’, there are no other obvious abdominal symptoms such as pain, fullness or distension.

Liver-Qi invading the Spleen

Straining in defecation, small stools, alternation of constipation and diarrhoea, stools sometimes dry and bitty and sometimes loose, abdominal distension, flatulence, tiredness, poor appetite, normal-coloured tongue (or slightly Red on the sides in severe cases of Liver-Qi stagnation), pulse Wiry on the left and Weak on the right.

Spleen- and Lung-Qi deficiency

Straining in defecation with a feeling of exhaustion afterwards, poor appetite, slight abdominal distension after eating, tiredness, pale complexion, weakness of the limbs, slight shortness of breath, slight cough, weak voice, spontaneous daytime sweating, dislike of speaking, tendency to catch colds, dislike of cold, Pale tongue, Empty pulse.

This pattern usually occurs in the elderly.

Spleen- and Kidney-Yang deficiency

Straining in defecation, occasionally loose stools, exhaustion after defecation, slight abdominal distension, lower backache, cold and weak knees, a feeling of cold, bright-white complexion, impotence, decreased libido, tiredness, lassitude, abundant clear urination, urination at night, poor appetite, a desire to lie down, early-morning diarrhoea, Pale and wet tongue, Deep-Weak pulse.

This pattern usually occurs in the elderly.

Kidney- and Liver-Yin deficiency

Straining in defecation, dry stools, dizziness, tinnitus, weak knees, hardness of hearing, lower backache, dull occipital or vertical headache, insomnia, numbness/tingling of the limbs, dry eyes, blurred vision, dry throat in the evening, dry hair and skin, brittle nails, night sweating, scanty menstruation or amenorrhoea, normal-coloured tongue without coating, Floating-Empty pulse.

Damp-Heat in the Intestines

Straining in defecation, mucus in the stools, foul-smelling stools, burning sensation in the anus, abdominal pain and fullness, a feeling of heaviness, sticky yellow tongue coating, Slippery-Rapid pulse.

Heat in the Intestines

Straining in defecation, small stools, a feeling of heat, thirst, red face, Red tongue with dry yellow coating, Deep-Full-Rapid pulse.

Diagnosis in Chinese Medicine A Comprehensive Guide

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