Guest guest Posted July 31, 2005 Report Share Posted July 31, 2005 This is a post for those new to TCM and the beginning TCM students on the list. Like most things, the symptom of constipation can have one or more of several underlying imbalances. Consider the stool shape, the stool moisture content, any pain, any straining, and color of stools in determining what the underlying imbalance(s) is (are). (From The Practice of , by Giovanni Maciocia, p. 478.) If the stools are round and small, this points to either Heat or Liver Qi Stagnation. If the stools are dry, this points to Heat. If they are not dry, this points to Liver Qi Stagnation. (p. 478) Heat dries things out. If the stools are long and thin - " like pencils " - this points to Spleen Qi Deficiency. This also can point to bowel cancer. (p. 478) Dry stools point to Heat - either Excess Heat or Deficiency Heat (Yin Deficiency). Since Yin not only cools and calms but also moistens, the dry stools also may be coming from there not being enough Yin to properly moisten. Maciocia recommends using thirst and drinking to determine which. In cases of Excess Heat, the person is going to be extremely thirsty and drink large amounts of cold water. In Yin Deficiency the mouth is dry and the person sips water. (p. 478.) (I would add that in some cases of Yin Deficiency, the person may feel thirsty but not drink a lot. Also, in the case of diabetes - which often has underlying Yin Deficiency - the person may feel very thirty and drink a lot. These are general comments. The pulse and tongue as well as other symptoms will give further information on differenciating Excess Heat from Deficiency Heat. Maciocia doesn't mention it in this intro section, but Blood Deficiency also can result in dry stools. He does go into this later on in the chapter. " Loose stools which are hesitant and difficult to come out indicate Spleen-Qi deficiency with stagnation of Liver-Qi. " (p. 478) These are stools that are not well-formed. They are not firm. Their composition is " loose " . " Watery, explosive stools splashing in all direction indicates either Damp-Heat (in which case the stools are yellow and frothy) or Damp-Cold. " (p. 478.) I would add that Damp Heat is extremely stinky and foul. Any time something is really stinky, suspect Damp Heat. Maciocia next goes into pain. " Constipation with abdominal pain points to stagnation of Liver-Qi or Cold. Pain from stagnation of Liver-Qi is not too severe and is accompanied by pronounced distension. " (p. 478.) Distension means an outward pressure. The person's clothes will actually feel tighter. The person may have to unbutton something. Spleen Deficiency also plays a role in a person tending to develop distension after eating. " Pain from Cold is severe and spastic. " (p. 478.) Is it ever! The extreme pain is not coming so much from the Cold but from the localized Blood Stasis caused by the Cold. The pain of Qi Stagnation is milder than that of Blood Stasis. The pain of Qi Stagnation is diffuse (no clearly defined borders) and tends to move around. Like gas pains. That of Blood Stasis is fixed and has definite boundaries. " Difficult defaecation with great effort indicates deficiency of Qi or Yang. This is also confirmed by a feeling of exhaustion after the bowel movement. " (p. 478.) Actually, one of the best indicators of Excess vs. Deficiency is does the person feel better after a bowel movement or tired? Cold can be due to Excess, or it can be due to Yang Deficiency (not enough Yang to properly warm the body). Excess Cold is due to cold invading the Intestines directly from the enviornment, or it's due to the person taking too many herbs or foods that cool the body too much. If the constipation is due to Excess of any kind, the person is going to feel better after going to the bathroom. If the constipation is due to Deficiency, the person is going to feel tired after going to the bathroom. Maybe even exhausted in some cases. So what happens when both Excess and Deficiency are present? After a bowel movement the person will feel tired but better in other ways. The person may even express that s/he feels like doing some things that s/he didn't feel like doing before but is now too tired to do them. Maciocia then goes into color: " Pale stools indicate Dampness, usually Damp-Heat in the Gall-Bladder. " (p. 478.) From the standpoint of anatomy and physiology, pale stools also can indicate poor metabolism of fats. " Dark stools indicate Heat. Green stools in children indicate Cold. " (p. 478.) The foods that one eats also can influence stool color. For example, eating spinach can make stools greenish in adults and children. If the stools are a tarry black, the person needs to see a DO or MD as this points to bleeding somewhere in the upper digestive tract. If the person is bleeding somewhere in the lower tract - especially near the anus, the blood will be red, and one can tell it is blood. (This too is cause to see a doctor.) But when the bleeding is in the upper or even middle digestive tract, by the time the blood is passed in bowel movements, it has turned black. Fiber laxatives containing psyllium can work very well in cases where the constipation is due to lack of moisture and/or lack of fiber in the diet. BUT, when the constipation or colonic inertia is due to Cold (either Excess or Deficiency), taking bulk laxatives alone can make the problem worse. Psyllium has a cooling effect on the body. In the case of people whose lack of bowel movements are due to Cold, taking psyllium alone is worsening the Cold and the constipation/ colonic inertia. In some of these cases, taking the psyllium with ginger tea will offset the problem. The thermal energy of dried ginger is Hot. It cancels out the cooling of the psyllium. Some constipation is due to a lack of peritalsis - the wavelike motions that move feces through the digestive system. This is called " colonic inertia " . And colonic inertia often will have an underlying Root of Qi or Yang Deficiency. The herb cayenne will increase peritalsis. However, cayenne also will scatter Qi. So you may want to be careful to supplement Qi if using cayenne regularly. Also to check for Qi Stagnation in cases of Qi Deficiency because adding more Qi without taking care of Qi Stagnation if it's also present will make pain and other problems worse. Magnesium deficiency also can manifest as constipation/ colonic inertia. Too little Mg will cause muscles to stay contracted. If they can't relax, obviously they can't produce the wavelike motions that move fecal matter along. Too little or too much Mg can be fatal. To sum up, the possible underlying TCM Roots of constipation are: Heat - " Chronic Interior Heat " or " Acute heat in febrile disease " Stagnation of Liver Qi Deficiency (Qi, Blood, Yang, and/or Yin Deficiency) Cold (p. 479.) Quote Link to comment Share on other sites More sharing options...
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