Constipation and Diarrhea

Question 0

What are deficiency causes of constipation?

Answer 0

Blood deficiency
Qi Deficiency
Yin Deficiency
Yang Deficiency 
Yang Deficiency With Cold accumulation

Question 1

What are excess causes of constipation?

Answer 1

Heat
Food Stagnation
Qi Stagnation
Phlegm

Question 2

Dry stool is seen in constipation from:

Answer 2

Heat, Yin or Blood deficiency

Question 3

Pebble or button like stool seen in constipation from:

Answer 3

Heat, Qi Stagnation

Question 4

Constipation or sluggish BM, possibly alternating with loose foul smelling stools, nausea and vomiting, acid reflux, indigestion, epigastric and abdominal fullness and distention, foul belching and flatulence, aversion to food. T: thick greasy coat. P: slippery.
Tx Strategy: Relieve food stagnation and harmonize the Stomach. Redirect Stomach Qi downward, promote bowel movement.
ST 25, SP 15; TW 6, GB 34; ST 37, BL 25, ST 44
+ PC 6; ST 40; ST 45, 40; SP 6, ST 36; SP 8, 4;
Bao He Wan

Answer 4

Food Stagnation

Question 5

Dry stools, infrequent BM, thirst, scanty-dark urine, red face, feeling of heat, abdominal pain, dry mouth, foul breath. T: red, yellow coat and red points around the centre and on the root. P: rapid and slippery

Answer 5

Heat in the Stomach and Large Intestine (causing constipation)

Question 6

Constipation, dry stools, abdominal pain and fullness red face, thirst, dry mouth, profuse sweating, feeling of heat, high fever.
T: Red with dry yellow coat.
P: Overflowing and Rapid
Tx Strategy: Drain Fire and promote downward movement of stools
Yang Ming Syndrome: ST 25, SP 15; TW 6; ST 37
+ LI 11, 4; GV 14; GB 39, TW 5, GB 34;

Answer 6

Acute Heat in Febrile Disease

Question 7

Chronic diarrhea with feeling of incomplete evacuation or tenesmus, stools may be purple or black, sticky or tarry, alternate with constipation.
Fixed and localized, sharp, stabbing abdominal pain, worse with pressure
Dark complexion, dark rings around eyes, purple nails

Spider veins or vascular abnormalities over the abdomen, face and legs around inner knee and ankle.
T: purple or with brown with purple stasis spots; sublingual veins dark and distended
P: wiry, choppy or thready
TX Strategy: Transform and eliminate stagnant Blood from the Intestines.
ST 25; CV 6; A shi; BL 17, 25; SP 10, 8, 6; LI 4, LIV 3
Shao Fu Zhu Yu Tang Drive Out Blood Stasis in the Lower Abdomen

Answer 7

BLOOD STAGNATION

Question 8

Desire to move stools but difficulty in doing so, great effort to open bowels, feeling of exhaustion afterwards, thin and long stools which are not dry, pale complexion, tiredness. If Spleen deficiency: muscular weakness, poor appetite. If Lung deficiency: slight breathless on exertion, weak voice. T: Pale. P: Empty
Tx Strategy: Tonify Qi, moisten the Intestines
ST 25, SP 15, CV 6; CV 12, ST 36, SP 6; BL 13, 20, 25
Huang Qi Tang Astragalus Decoction
Zhi Huang Qi, Dang Shen, Chao Bai Zhu, Chen Pi, Huo Ma Ren, Feng mi (honey)

Answer 8

Qi Deficiency

Question 9

Dry stools, thirst with desire to sip water, dry mouth and throat especially in the evening, sore back and knees, dizziness, tinnitus, night sweating.
T: Red without coat, cracks. P: Floating-Empty
Tx Strategy: Nourish Yin, tonify the Kidneys and moisten the Intestines.
ST 25, 36; CV 4, 12; SP 6; BL 25, 20 21, 23;
KD 3, 6; Herbs are very effective
Liu Wei Di Huang Wan Rehmannia Six Decoction
Yi Wei Tang Benefit the Stomach Decoction
Zeng Ye Tang Increase the Fluids Decoction

Answer 9

Yin Deficiency

Question 10

Chronic constipation or sluggish stools which are not dry and may contain mucus, tenesmus, after BM patient feels lighter and clear headed. Abdominal distention, discomfort, foggy headedness, poor concentration, poor memory, sleepiness, lethargy, chronic mucus from sinuses and lungs, greasy skin, musty body odor, dizziness, h/a triggered by strong smells, obesity, pear shape. T: flabby, swollen with a greasy white coat, thicker on root. P: deep, slippery or wiry. Tx Strategy: Transform, eliminate phlegm, open bowels, elevate Yang to descend turbid Yin, regulate Liver Qi, strengthen Spleen. ST 25, SP 15; TW 6, GB 34; ST 40, SP 3, ST 41, 36; CV 12; LI 4, LV 3;

Answer 10

Phlegm Accumulation

Question 11

Constipation with hard to expel stools that may or may not be dry; patient exhausted after defecation, copious clear urine, nocturia, scanty urination, pitted edema, cold extremities, aversion to cold, abdominal pain better with warmth, feels cold with palpation, waxy pale complexion, lower back ache and knee soreness. T: pale, swollen, moist, tooth marks, white coat. P: deep, slow. Tx: Warm, tonify Yang, promote BM, fluid metabolism
ST 25, SP 15; CV 4; BL 20, 23, 25; GV 4; ST 36, SP 6 KD 3; Ji Chuan Jian Benefit the River Decoction

Answer 11

Yang Deficiency, Cold Accumulation

Question 12

What are the excess causes of diarrhea?

Answer 12

Invasion of External pathogens
Damp Heat
Cold Damp
Food Stagnation
Liver Qi Stagnation
Blood Stasis

Question 13

Dry stools, difficulty with defecation, dull-pale complexion, dizziness, numbness of the limbs, blurred vision.
T: Pale or normal.
P: Empty
Tx Strategy: Nourish blood, moisten intestines
CV 12, ST 36, SP 6; ST 25; CV 6, 4; BL 17, 18, 20, 23; SP 10
Diet and herbal therapy very effective
Run Chang Wan Moisten the Intestines Pill
Dang Gui, Sheng di Huang, Tao Ren, Huo Ma Ren, Zhi Ke

Answer 13

Blood Deficiency

Question 14

What are the deficiency causes of diarrhea?

Answer 14

• -Spleen and Stomach deficiency
• -SP/KD Yang deficiency
• -Fluid Accumulating in the Intestines

Question 15

Dry stools, infrequent BM, thirst, bitter taste, dark urine, H/A, irritability, red face, blood shot eyes. T: Red, redder on sides, dry yellow coating. P: Wiry, rapid

Answer 15

Heat in the LV (causing constipation)

Question 16

Acute, frequent, urgent, foul, explosive diarrhea
Relatively high fever unrelieved by sweating
May or may not be sweating
Thirst, dry mouth
Concentrated urine
Irritability and restlessness
Heaviness in the body, foggy-headedness, H/A
Nausea and vomiting
Fatigue and lethargy
Possible sore throat
Sx worse at mid afternoon
T: greasy white or yellow
P: floating, rapid, soggy, soft
TX Strategy: Clear the exterior and dispel heat. Clear Heat, transform and eliminate Dampness.
LI 11, 4; ST 25, 37; SP 9; BL 25; Zhi Xie (half way between CV 8 and the pubic bone)
Huo Xiang Zheng Qi San

Answer 16

SUMMERHEAT

Question 17

Direct strike of Cold or Yang deficiency of the Spleen and Kidneys
Difficult defecation, stools not dry, no BM for several days, spastic abdominal pain, pale urine, pale face, cold limbs, feeling cold.
T: Pale and wet, thick white coat on root
P: Deep-slow-full-tight.
Yang deficiency: Deep-slow-fine, tight in KD
Tx: Warm Yang, scatter Cold, promote BM
ST 25, BL 23, 25; CV 6, 4; KD 6; + Moxa
Ma Huang Fu Zi Xi Xin Tang
Ephedra, Asarum, and Prepared Aconite Decoction

Answer 17

Full Cold

Question 18

Lower back and knee soreness or weakness
Poor appetite or anorexia, poor digestion, abdominal distention
Fatigue, exhaustion, depression and general disinterest, increased desire to sleep
T: pale and swollen, scalloped, white coat
P: deep, thready and weak
TX Strategy: Warm, strengthen, supplement SP/KD, astringe Intestines, stop diarrhea
ST 25; CV 8 moxa; CV 4; ST 36; SP 6; KD 3; GV 4; BL 20, 23, 25; GV 20
Li Zhong Wan Ginseng and Ginger Formula

Answer 18

SP & KID YANG DEFICIENCY

Question 19

Acute or recurrent, frequent, urgent, foul smelling, hot diarrhea with a burning anus and/or tenesmus
Fever or afternoon fever unrelieved by sweating
Sweating occurring in waves, worse in afternoon
Restlessness and irritability
Cramping abdominal pain
Concentrated and scanty urine
Thirst
T: greasy yellow coat, may have red body
P: slippery and rapid
TX Strategy:  
	Clear Damp Heat from the Intestines.
	Stop diarrhea
LI 11, ST 25, 44; SP 9; ST 37; Zhi Xie;
\+ GV 14, LI 4 fever; PC 6 nausea; 
Ge Gen Huang Gen Huang Lian Tang

Answer 19

Invasion of pathogenic Damp Heat, but can also be generated internally, concentrated in the Intestines

Question 20

Acute diarrhea with borborygmus, cramps, watery and urgent in severe cases; Chills, possible mild fever, No sweating; Generalized muscle aches, dull occipital or general H/A; Nausea and possible vomiting; Fullness and discomfort in upper and mid Jiao; Lethargy, malaise, heaviness in head and body, foggy headedness
T: thin or greasy white
P: floating, soft or slippery, possibly tight
TX Strategy:
Clear Exterior and dispel Summerdamp
Dispel Cold, transform and eliminate Dampness

LI 11, 4; ST 25, 37; SP 9; BL 25; Zhi Xie (half way between CV 8 and the pubic bone; moxa if Cold)

Answer 20

SUMMERDAMP

Question 21

Overindulgence in cold, raw food, fruit, juices or tea, exposure to external Cold and damp; can be acute or intermittent; the presence of Cold damp in GI system with no exterior Sx.
Acute, chronic or recurrent, loose to watery, urgent. Patient may double up to warm abdomen and dislikes abdominal palpation
Cramping or colicky abdominal pain
Borborygmus
Fullness and distention in epigastrium/abdomen
Loss of appetite, reduced sense of taste
Nausea
Increased desire to sleep
Heavy sensation in the body
Clear urine
T: thick greasy white coat
P: moderate, slippery or soft
TX Strategy: Warm, dry Cold Damp, strengthen the Spleen, and stop diarrhea
ST 25, 36, 37; SP 9, 6, 3; BL 25; Zhi Xie; moxa box
Ping Wei San Magnolia and Ginger Formula

Answer 21

COLD DAMP

Question 22

Clear, watery, frothy diarrhea; more water
Borborygmus, water sloshing sounds upon palpation
Emaciation
nausea/vomiting clear fluids, abdominal distention
Scanty urine
Dry mouth
dizziness

T: pale with greasy white coating
P: slippery or soggy
TX Strategy: Warm and strengthen the Spleen and fluid metabolism.
Drain Damp by promoting diuresis (or expulsion through the bowel).
CV 9, ST 28; CV 4, 6, SP 9, 6; BL 39; KD 7; ST 36; BL 20, 23, 28
Ling Gui Zhu Gan Tang Ji Jiao Li Huang Wan

Answer 22

FLUID RETENTION IN INTESTINES

Question 24

Constipation with stools shaped like pebbles but not dry, desire to open the bowels but difficulty in doing so, belching, abdominal distention, irritability. T: normal color or slightly red on sides P: Wiry, may be wiry on just the left side
Tx Strategy: Pacify the Liver, regulate Qi, make Qi descend, eliminate stagnation.
ST 25; CV 6; TW 6, GB34; ST 37; LIV 3, 5
+ HT 7, PC 6, Yin Tang, GV 24; for extreme emotions
A shi pts. on lower ST channel, palpate
Liu Mo Tang Tong Xie Yao Fang

Answer 24

Stagnation of Liver Qi

Question 24

Related to overindulgence or irregular eating habits, Spleen deficiency with elements of Dampness. Can be excess or mix of excess and Spleen deficiency.
Acute or chronic diarrhea, foul smelling stools, possible undigested food
Abdominal, epigastric distention, pain worse with pressure, or borborygmus all relieved by diarrhea or belching

Foul belching, halitosis
Acid reflux, nausea
Foul flatulence
T:  thick white or yellow greasy coat
P:  wiry and slippery and rapid
TX Strategy:  Alleviate stagnation, harmonize ST, Clear Damp Heat, transform Phlegm, warm ST, strengthen Spleen
CV 12; ST 25, 36, 37, 40, 44; LI 10
\+ SP 8, LIV 5 abdominal pain; SP 4, 5 abdominal bloating
Bao He Wan Citrus and Crategus Formula

Answer 24

FOOD STAGNATION

Question 25

Frequent loose stools or diarrhea, with mucus constant or intermittent worse with fatigue, over-exertion, certain foods. BM after meals. Alternate diarrhea and constipation
Abdominal distention, dull ache, better warmth
Poor appetite, decrease taste sense, nausea
Weakness, fatigue, tired after eating
Weak, tired limbs
Pale complexion and lips
Puffiness around eyes and in the fingers
Weight loss
T: pale, scalloped, white coat
P: weak, thready, deficient, moderate
TX Strategy: Strengthen the Spleen and supplement Qi, Dry dampness and stop diarrhea
CV 12; ST 25, 36; Zhi Xie; SP 9, 6, 5; BL 20, 21, 25
Severe, moxa GV 20
Shen Ling Bai Zhu San Ginseng & Atractylodes Formula

Answer 25

SP & ST QI DEFICIENCY

Question 26

Recurrent diarrhea, urgent and preceded by cramping abdominal pain, pain relieved by defecation. May alternate with constipation. Worse with stress. Abdominal distention; Poor appetite, nausea; Heartburn, indigestion; Borborygmus; Flatulence and belching; hyponchodriac discomfort; Irritability; Should and neck tension; Cold fingers and toes; PMS and breast tenderness
T: normal or darkish body, or pale with slightly red edges; greasy coat
P: wiry
TX Strategy: Harmonize the Liver and Spleen, regulate the Liver Qi, support and strengthen the Spleen, alleviate spasm and pain, stop diarrhea.
CV 12, LIV 13, ST 25; PC 6, ST 36; SP 6; LI 4; LIV 3
BL 18, 25; Yin Tang; A shi; TW 5, GB 39, GV 24
Tong Xie Yao Fang Important Formula for Painful Diarrhea

Answer 26

LIVER QI INVADING SPLEEN