1. DIARRHEA
Lee Chong Leng

3. CONTENTS 1) Introduction 4 2) Clinical Manifestations 10 - 15 3)
Essentials for Diagnosis 4)
Treatment with Tuina Therapy 5)
Cautions 43

4. DIARRHEA May occur at any time, especially in summer and autumn
Frequent and sloppy stool, sometimes even appearing like water
Similar to intestinal inflammation, chronic enteritis, gastrointestinal neurosis and non-specific ulcerated colitis in Western medicine

5. DIARRHEA

10. CLINICAL MANIFESTATIONS
1. Acute diarrhea
(1) Attack of dampness
(2) Improper diet
2. Chronic diarrhea
(1) Deficiency of spleen & stomach
(2) Yang deficiency of kidney & spleen
(3) Liver Qi over-straining the spleen

11. ACUTE DIARRHEA Attack of dampness
Sudden onset with thin and loose stool or mixed with mucus, ten times a day
Accompanied by abdominal pain, borboygmus, aching pain of the extremities, yellowish or whitish greasy tongue coating, soft or rapid and slippery pulse

12. ACUTE DIARRHEA Improper diet
Sudden onset with a history of improper diet, diarrhea with rotten egg smell
Accompanied by abdominal distension, foul belching, alleviation of pain after diarrhea, acid regurgitation, thick greasy tongue coating, soft or rapid slippery pulse

13. CHRONIC DIARRHEA Deficiency of spleen and stomach
Usually occur after taking greasy, oily food, marked by loose or watery stool
Poor appetite, pale tongue with whitish tongue coating, slow and weak pulse

14. CHRONIC DIARRHEA Yang deficiency of kidney and spleen
Diarrhea accompanied by pain around the umbilicus occurring at dawn and right after borboygmus
Pain is relieved after diarrhea
Other symptoms include cold feeling in abdomen, aching and coldness in the waist and limbs, pale tongue with whitish coating, deep and thin pulse

15. CHRONIC DIARRHEA Liver Qi over-restraining the spleen
Often induced by excessive emotional changes
Accompanied by abdominal pain, borborygums, full sensation in the chest and hypochondriac regions, belching, thin tongue coating, taut and thin pulse

16. ESSENTIALS FOR DIAGNOSIS
1. Loose or watery feces, increased frequency, often abdominal distension
2. Sudden onset of acute fulminate diarrhea with short duration, aversion of cold and fever
3. Slow onset of chronic diarrhea with longer duration and frequent relapse and fluctuation

17. ESSENTIALS FOR DIAGNOSIS
4. Improper diet, cold attack or emotional changes that can lead to diarrhea
5. Red and white blood cells can be seen in stool test, the bacteria culture of stool is either positive or negative
6. Barium meal X-ray examination or intestinal endoscope should be done if necessary

18. Treatment with tuina therapy
Principle:
Invigorating the spleen and harmonizing the stomach, warming the kidney to strengthen yang, soothing the liver to regulate Qi

19. Treatment with tuina therapy
Acupoint and location:
Zhongwan (CV 12), Tianshu (ST 25), Qihai (CV 6), Guanyuan (CV 4)
Pishu (BL 20), Weishu (BL 21), Shenshu (BL 23), Dachangshu (BL 25) and Changqiang (GV 1)

20. TREATMENT WITH TUINA THERAPY
Operation 1:
Patient - lateral recumbent position
Push first gently and then strongly from Zhongwan (CV 12) down to Qihai (CV 6) and Guanyuan (CV 4) for 5-6 times
Rub the abdomen counter-clockwise for about 8 minutes.

21. Zhongwan (中脘)，Tianshu (天枢)，Qihai (气海)

22. Guanyuan (关元)

23. TREATMENT WITH TUINA THERAPY
Operation 2:
Patient - prone position
Roll from Pishu (BL 20) to Dachangshu (BL 25), 1 minute each
Press Pishu (BL 20), Weishu (BL 21), Dachangshu (BL 25) and Changqiang (GV 1) repeatedly for about 3-4 times
Rub the left side of the back until it is warm for about 10 minutes

24. Geshu (膈俞)，Ganshu (肝俞)，Pishu (脾俞)，Shenshu (肾俞)

25. Shenshu (肾俞)，Dachangshu (大肠俞)

26. Weishu (胃俞)

27. Changqiang (长强)

28. MANIPULATIONS ACCORDING TO SYNDROME DIFFERENTIATION

29. (1) COLD AND DAMPNESS
Rub Shenque (CV 8), Qihai (CV 6) until the abdomen becomes warm
Press and rub Zusanli (ST 36) and Neiguan (PC 6) for 1 minute each
Rub the left side of the back and lumbosacral region till it turns warm

30. Shenque (神阙)

31. Zusanli (足三里)

32. Neiguan (内关)

33. Rub the abdomen clockwise
(2) IMPROPER DIET
Rub the abdomen clockwise

34. (3) GASTRICSPLENIC DEFICIENCY
Rub Guanyuan (CV 4) and Zusanli (ST 36) gently for 2 minutes each
Rub Qihai (CV 6) for a longer period of time
Rub the whole abdomen anticlockwise, mainly focusing on the epigastric region
Rub the lower abdomen clockwise

35. (4) YANG DEFICIENCY IN BOTH SPLEEN AND KIDNEYS
Rub gently Qihai (CV 6) and Guanyuan (CV 4) for 3 minutes each
Rub vertically the govern vessel on the back
Rub transversely Shenshu (BL 23), Mingmen (GV 4) and Baliao

36. Mingmen (命门)

37. Baliao (八髎)

38. (5) LIVER QI OVER RESTRAINING THE SPLEEN
Press and knead gently Zhangmen (LR 13) and Qimen (LR 14) for about minutes
Rub obliquely backward and forward hypochodrium region until it is slightly warm
Rub Ganshu (BL 18), Danshu (BL 19), Geshu (BL 17), Taichong (LR 3) and Xingjian (LR 2)

39. Qimen (期门)，Zhangmen (章门)

40. Geshu (膈俞)，Ganshu (肝俞)，Pishu (脾俞)，Shenshu (肾俞)

41. Danshu (胆俞)

42. Dadun (大敦)，Xingjian (行间)，Taichong (太冲)

43. CAUTIONS
1. Abstain from starch and fat food, avoid food difficult to digest
2. Keep warm, avoid overstrain and pay attention to mental state and diet

44. THANK YOU