Basics of Constipation(The pain of Cold constipation)

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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.)