CONSTIPATION

Lee Chong Leng

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CONTENTS1) Introduction 3 - 72) Causes 8 -123) Clinical Manifestations 13 - 204) Diagnosis and

Evaluation21- 22

5) Treatment with Tuina Therapy

23 - 45

6) Cautions 46 - 472

CONSTIPATION

Varying bowel movement pattern

Discomfort with irregular or difficult bowel movement

Dry, hard stools

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THE DIGESTIVE SYSTEM

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THE BOWEL IN THE BODY

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CONSTIPATION

Dry stools that causes

Difficulty defecation

Prolonged defecation

Unsmooth defecation

It may occur alone or may be complicated with other diseases

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CONSTIPATION1) Acute constipation: Begins suddenly and conspicuously

2) Chronic constipation: May begin gradually and persist for months or years

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CAUSES OF CONSTIPATION

Dysfunction of the large intestine :

retention of feces in the intestines excessive absorption of fluid in the stool

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BRISTOL STOOL CHART

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CAUSES OF CONSTIPATION Not eating enough fiber or

drinking enough fluid

Irregular toilet habits

Certain medical conditions

Medicine taken for other illnesses

Pregnant women

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CAUSES OF CONSTIPATION

Withhold stool and the intestines reabsorb the water in the stool

Withhold stool when one is not comfortable having a bowel movement

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CAUSES OF CONSTIPATION

Old people: Age-related changes in the large intestine Increased use of drugs Low-fiber diet Reduced physical activity Slowed transit during periods of illnessEnlarged rectum with age

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CLINICAL MANIFESTATIONS

Dry stools

Difficulty in defecation

Normal frequency of defecation with dry feces

Difficulty in defecation in spite of desire to discharge

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CLINICAL MANIFESTATIONS

Prolonged constipation will lead to Abdominal distensionStomachacheVertigoAnorexiaUncomfortable sleepHemorrhoids and anal fissure

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CLINICAL MANIFESTATIONS

BASED ON SYNDROME DIFFERENTIATION

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(1) HEAT ACCUMULATION IN

STOMACH AND INTESTINES

Dry stool, fullness in the abdomen

Flushed face, warm feeling in the body

Restlessness, foul breath, dry mouth, sores on lips

Red tongue with yellow or dry yellow coating

Slippery and forceful pulse 16

(2) STAGNATION OF QI

Constipation without dry feces, abdominal distension involving the hypochondrium

Frequent belching, poor appetite

Mental depression, irritability, restlessness

Thin whitish tongue coating

Taut pulse 17

(3) DEFICIENCY OF QI AND BLOOD

1) Due to Qi deficiency:

Difficult defecation, weakness to defecate, defecation without dry feces

Profuse sweating and short breath

Pale tongue with thin, whitish coating

Weak and soft pulse 18

(3) DEFICIENCY OF QI AND BLOOD

2) Due to blood deficiency: Dry stoolGrayish complexionVertigo, palpitationPale tongueThin pulse

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(4) STAGNATION OF YIN COLD

Difficult defecation Pale complexion Cold limbs, cold pain

in abdomen, soreness and cold on the back

Profuse and clear urine

Pale tongue with whitish coating

Deep and slow pulse

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ESSENTIALS FOR DIAGNOSIS

1)Defecation is prolonged once every two or more days

2)Dry stool like nuts accompanied by abdominal distension, lassitude and poor appetite

3)Rule out intestinal organic diseases

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EVALUATION ON CONSTIPATION

For new case, check on the change in diet or physical activity or new use of a drug

Perform blood tests to check for an under-active thyroid gland (hypothyroidism) or high calcium levels in the blood (hypercalcemia)

Possible cause due to cancer, a colonoscopy is performed

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TREATMENT WITH TUINA THERAPY

Principle:

Regulating intestine and Qi to promote defecation.

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ACUPOINTSABDOMEN BACK

Zhongwan (CV 12) 中脘 Ganshu (BL 18) 肝俞

Tianshu (ST 25) 天枢 Pishu (BL 20) 脾俞Daheng (SP 15) 大横 Shenshu (BL 23) 肾俞

Dachangshu (BL 25) 大肠俞

Baliao 八髎Changqiang (GV 1) 长强

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OPERATION The patient in supine position

Rub gently Zhongwan 中脘 (CV 12), Tianshu 天枢 (ST 25) and Daheng 大横 (SP 15) with one-finger pushing method

Rub the abdomen clockwise with the palm

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

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Daheng ( 大横 )

OPERATION The patient in prone position Rub gently along the bilateral side

of the spine from Ganshu 肝俞 (BL 18) and Pishu 脾俞 (BL 20) to Baliao 八髎

Press and rub gently Shenshu 肾俞 (BL 23), Dachangshu 大肠俞 (BL 25), Baliao 八髎 and Changqiang 长强 (GV 1)

Rub the back with rolling manipulation

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

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Shenshu ( 肾俞 ) ， Dachangshu (大肠俞 )

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Baliao ( 八髎 )

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Changqiang ( 长强 )

TREATMENT BASED ON SYNDROME

DIFFERENTIATION

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(1) HEAT ACCUMULATION IN STOMACH AND INTESTINES

Rub horizontally Baliao 八髎 until it is warm inside

Press and rub Zusanli 足三里 (ST 36) and Dachangshu 大肠俞 (BL 25) until aching and distending feeling is felt

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Zusanli ( 足三里 )

(2) STAGNATION OF QI Press and rub Zhongfu 中府 (LU

1), Yunmen 云门 (LU 2), Shanzhong 膻中 (CV 17), Zhangmen 章门 (LR 13), Qimen 期门 (LR 14), Feishu 肺俞 (BL 13), Ganshu 肝俞 (BL 18) and Geshu 膈俞 (BL 17) until aching and distending feeling is felt

Rub horizontally backward and forward the chest until it is warm

Rub backward and forward obliquely the hypochondriac region until it becomes slightly warm

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Zhongfu ( 中府 ) ， Yunmen (云门 )

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Shanzhong ( 膻中 )

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Qimen ( 期门 ) ， Zhangmen (章门 )

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Dazhui ( 大椎 ) ， Feishu (肺俞 )

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

(3) DEFICIENCY OF QI AND BLOOD

Rub the upper part of the chest, the left back and Baliao 八髎 points in sacral region until it is warm

Press and rub Zusanli 足三里 (ST 36) and Zhigou 支沟 (TE 6)

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Zhigou ( 支沟 )

(4) STAGNATION OF YIN COLD

Rub horizontally the shoulder, back region and Shenshu 肾俞 (BL 23), Mingmen 命门 (GV 4) and Baliao 八髎 points in the lumbosacral region until it is warm

Rub vertically the governor vessel until it is warm

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Shenshu ( 肾俞 ) ， Mingmen ( 命门 )

CAUTIONS

1) Drink sufficient water every day

2) Eat food rich in fiber and avoid junk food

3) Take some outdoor activities and exercises to strengthen the abdominal muscle

4) Develop a regular toilet habit

5) Get plenty of rest

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THANK YOU

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