1. Asian Bodywork III Class 8 Timur Lokshin LMT, CPT, LAc.

2. Diarrhea Refers to condition in which the frequency of bowel movement is increased, stools are soft and runny or, in sever cases, the stools are like water. In Chinese diarrhea is translated as loose unformed stools with rather mild sensation of elimination and runny watery stools with acute sensations during elimination. Diarrhea can occur in any of the four seasons but most commonly seen in summer and autumn.

3. Diarrhea Patterns Acute or Chronic Enteritis (SI) Indigestion Intestinal Parasitic Disease Disorders of the Pancrease, Liver or Gallbladder Endocrinic Metabolic Disorders Emotional Stress

4. Etiology The etiology of diarrhea is often complex. A constant factor in its pathogenesis however is disruption of the normal function of the spleen and stomach. Clinically, diarrhea is divided into acute or chronic conditions based on etiological factors and the duration of the illness.

5. Pathogenesis Acute diarrhea is often brought on by internal injury because of improper diet, external evils such as cold, heat, dampness and summerheat, or emotional stress leading to disharmony of LV and SP. Chronic diarrhea is most often caused by vacuity of the SP and KD leading to disruption of the T & T function of the SP

6. Causes Attack of External Cold and Dampness Attack of External Damp-Heat Retention of Food in the ST and Intestines Disharmony of the LV and SP Vacuity of the Spleen and ST Vacuity of KD Yang

7. Attack of External Cold and Dampness Sx: Diarrhea with watery stools, borborygmus, abdominal pain, congestion in the epigastrium and loss of appetite. May include fever, aversion to cold, stuffy nose, headache, no thirst, general aches and pain. – Tongue: Thin white slimy coat – Pulse: Soft, tardy Tx: ST25, Ren12, ST36, SP9

8. Attack of External Damp-Heat Sx: Diarrhea, abdominal pain, urgent bowel movements or diarrhea with difficulty in defecation, yellow pasty foul stools, burnins sensation in the anal region, irritability, thirst, dark scanty urine. – Tongue: Yellow slimy coating – Pulse: Slippery Tx: ST25, ST36, LI11

9. Retention of Food in the ST and Intestine Sx: Abdominal Pain, borborygmus, stools foul with rotten egg odor, abdominal pain relieved after bowel movement, fullness of the epigastrium and abdomen, belching of foul gas, acid reflux, loss of appetite – Tongue: Thick, slimy or filthy coating – Pulse: Slippery Tx:ST25, Ren12, ST36, Li Nei Ting (Opposite side of ST44)

10. Disharmony of the LV and SP Sx: Distension and congestion in the chest and hypochondrium, belching, poor appetite, abdominal pain and diarrhea brought on by depression, anger or anxiety, no releife of pain with bowel movement. – Tongue: Thin white coat – Pulse: Wiry Tx: ST 25, Ren12, St36, LV2 or LV3 (depending on patients current state)

11. Vacuity of SP and ST Sx: Loose stools, increased frequency of bowel movement with consumption of greasy oily foods, loss of appetite, epigastric fullness and discomfort after eating, sallow complexion, lack of vitality, fatigue. – Tongue: Pale with white coat – Pulse: Weak, thready Tx: ST25, ST36, SP3

12. Vacuity of KD and SP Yang Sx: Diarrhea usually occurring just before dawn, abdominal coldness and pain and borborygmus prior to bowel movement, physical cold, cold extremities, sore weak lower back and knees. – Tongue: Pale with white coating – Pulse: Deep, weak, thready Tx: ST36, KD3, Ren 4 or UB23 (with heat)

13. Diarrhea Massage Place both hands on top of each other over the left lower quadrant and begin to slowly and gently move the hands counter- clockwise. Superior, transverse, inferior, transverse. This technique is done for roughly 2 minutes. It will stabilize bowel movement and help contain the urge.

14. Constipation Translated as Fecal Block, referring to conditions in which the bowels have difficulty evacuating stools. This includes conditions where the feces are too hard to pass, where too much time is spent moving bowel, or where evacuation is difficult even though the sensation of needing to move the bowel is present. The major factor causing constipation is the dysfunction of the LI.

15. Some Biomed Causes Neurosis During recovery of enteritis Postpartum Post surgery or illness During pathological conditions of the rectum or anus.  For cases of high fever and constipation, it is treated as a febrile disease.

16. TCM Causes Heat Constipation Qi Stagnation Constipation Qi Vacuity Constipation Blood Vacuity Constipation Cold Constipation

17. Heat Constipation Sx: Constipation, elimination at several day intervals, dark scanty urine, flushed complexion, fever, thirst, halitosis and abdominal distention with pain in some cases. – Tongue: Red with dry yellow coating – Pulse: Rapid, slippery Tx: ST25, LI4, LI11

18. Qi Stagnation Constipation Sx: Constipation, frequent belching, sensation of stuffiness and blockage in the chest and hypochondrium, reduced food intake and abdominal distention and pain in sever cases. – Tongue: Thin slimy coat – Pulse: Wiry Tx: ST25, LI4, LV3

19. Qi Vacuity Constipation Sx: Difficult elimination despite the need to move the bowels, the stools are neither too hard nor dry and there is neither abdominal pain nor distention. These types of symptoms may be accompanied by SoB, spontaneous perspiration, fatigue or tiredness – Tongue: Pale, delicate – Pulse: Weak Tx: ST25, Ren12, Ren4

20. Blood Vacuity Constipation Sx: Dry hard stool, pale complexion, dizziness and vertigo, palpitations, pale lips. – Tongue: Pale – Pulse: Rough, thready Tx: ST25, Ren4, ST36

21. Cold Constipation Sx: Difficult elimination with clear copious urine, pale complexion, dizziness and vertigo, cold extremities, a preference for heat and an aversion to cold, abdominal coldness and pain, coldness and aching of the lower back and knees. – Tongue: Pale with white coating – Pulse: Slow, deep Tx: ST25, Ren 6 and Ren 4 apply heat.

22. Constipation Massage Place both hands on top of each other over the right lower quadrant and begin to slowly and gently move the hands clockwise. Superior, transverse, inferior, transverse. This technique is done for roughly 2 minutes. It will promote bowel movement and release constipation.