Difficult defecation

Difficulty in evacuating the bowels with evacuation at long intervals. Difficult defecation differs from constipation on three points.

1. In constipation, evacuation is once every other day, or may occur only after several days, whereas in difficult defecation, stool is passed, usually about once a day.
2. In constipation, the stool is always dry and hard, whereas in difficult defecation, the stool is is not necessarily hard, although it may be dry and bound like jujubes or chestnuts.
3. Constipation is usually associated with abdominal discomfort, whereas difficult defecation usually is not. Difficult defecation occurs in the following patterns: large intestine heat bind, brewing damp-heat, spleen-lung qì vacuity, liver-spleen qì stagnation, spleen-kidney yáng vacuity, and yīn vacuity and blood depletion.

Patterns

Large intestine heat bind (热结大肠 rè jié dà cháng) causes difficult defecation with hard stool or pelleted stool. Accompanying signs include abdominal fullness and distension or distension and pain that refuses pressure, red face and ears, heart vexation, agitation, thirst, and yellow urine. The tongue is dry with slimy fur or rough and yellow. The pulse is sunken, replete, and forceful.

Medicinal therapy: Drain heat and free the stool. Use Stomach-Regulating Qì-Coordinating Decoction (调胃承气汤 tiáo wèi chéng qì tāng).

Acumoxatherapy: Base treatment mainly on LI and ST. Select LI-4 (Union Valley, 合谷 hé gǔ), LI-11 (Pool at the Bend, 曲池 qū chí), ST-44 (Inner Court, 内庭 nèi tíng), BL-25 (Large Intestine Transport, 大肠俞 dà cháng shù), ST-25 (Celestial Pivot, 天枢 tiān shū), SP-14 (Abdominal Bind, 腹结 fù jié), ST-37 (Upper Great Hollow, 上巨虚 shàng jù xū), and KI-6 (Shining Sea, 照海 zhào hǎi); needle with drainage.

Brewing damp-heat (湿热蕴结 shī rè yùn jié) causes difficult defecation with sticky grimy turbid stool, or hard stool followed by sloppy stool, or alternating diarrhea and constipation. Other signs include sagging distension in the lesser abdomen, glomus in the stomach duct and oppression in the chest, heavy body, bitter taste in the mouth, absence of thirst, and short voidings of reddish urine. The tongue fur is yellow and slimy. The pulse is rapid and slippery.

Medicinal therapy: Minor Qì-Coordinating Decoction (小承气汤 xiǎo chéng qì tāng) plus anemarrhena (Anemarrhenae Rhizoma, 知母 zhī mǔ) and phellodendron (Phellodendri Cortex, 黄柏 huáng bǎi).

Acumoxatherapy: Base treatment mainly on LI, ST, and SP. Select LI-4 (Union Valley, 合谷 hé gǔ), LI-11 (Pool at the Bend, 曲池 qū chí), ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), SP-9 (Yīn Mound Spring, 阴陵泉 yīn líng quán), BL-25 (Large Intestine Transport, 大肠俞 dà cháng shù), and ST-25 (Celestial Pivot, 天枢 tiān shū); needle with drainage.

Spleen-lung qì vacuity (脾肺气虚 pí fèi qì xū) causes difficult ungratifying defecation associated with straining. Other signs include sweating, shortness of breath, hasty panting, exhaustion of essence-spirit, fatigued limbs, scantness of breath and laziness to speak, low timid voice, empty sagging in the smaller abdomen, in some cases with prolapse of the rectum. The tongue is enlarged and soft with dental impressions at the margins. The pulse is vacuous and forceless.

Medicinal therapy: Supplement the spleen and lung. Use Center-Supplementing Qì-Boosting Decoction (补中益气汤 bǔ zhōng yì qì tāng) plus apricot kernel (Armeniacae Semen, 杏仁 xìng rén) and trichosanthes seed frost (Trichosanthis Seminis Pulvis, 栝楼仁霜 guā lóu rén shuāng).

Acumoxatherapy: Base treatment mainly on back transport points, CV, and TB. Select CV-17 (Chest Center, 膻中 shān zhōng), BL-20 (Spleen Transport, 脾俞 pí shù), BL-21 (Stomach Transport, 胃俞 wèi shù), BL-25 (Large Intestine Transport, 大肠俞 dà cháng shù), CV-6 (Sea of Qì, 气海 qì hǎi), CV-4 (Pass Head, 关元 guān yuán), ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), and TB-6 (Branch Ditch, 支沟 zhī gōu); needle with supplementation and moxa.

Liver-spleen qì stagnation (肝脾气滞 gān pí qì zhì) causes difficult defecation with distress and heaviness in the rectum, ungratified desire to defecate, and flatus that relieves abdominal discomfort. Other signs include distension and pain in the rib-side, mental depression, and belching. In women, there is premenstrual distension of the breasts. The pulse is stringlike or sunken and stringlike.

Medicinal therapy: Normalize qì and abduct stagnation; downbear qì and free the stool. Use Six Milled Ingredients Decoction (六磨汤 liù mò tāng).

Acumoxatherapy: Base treatment mainly on CV and LR. Select CV-12 (Center Stomach Duct, 中脘 zhōng wǎn), GB-34 (Yáng Mound Spring, 阳陵泉 yáng líng quán), LR-3 (Supreme Surge, 太冲 tài chōng), ST-25 (Celestial Pivot, 天枢 tiān shū), CV-6 (Sea of Qì, 气海 qì hǎi), and LR-2 (Moving Between, 行间 xíng jiān); needle with drainage.

Spleen-kidney yáng vacuity (脾肾阳虚 pí shèn yáng xū) causes difficult defecation with dry or normal stool. It is especially common among the elderly. Accompanying signs include physical cold and fear of cold exhaustion of essence-spirit, and limp aching lumbus and knees. Urinary signs include long voidings of clear urine, profuse urination at night, and dribble after voiding. The tongue is pale and enlarged with dental impressions at the margins. The tongue fur is white and moist. The pulse is slow or sunken.

Medicinal therapy: Warm yáng and supplement the kidney. Use Ferry Brew (济川煎 jì chuān jiān).

Acumoxatherapy: Base treatment mainly on CV, SP, KI and back transport points. Select CV-6 (Sea of Qì, 气海 qì hǎi), ST-25 (Celestial Pivot, 天枢 tiān shū), KI-6 (Shining Sea, 照海 zhào hǎi), SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), BL-20 (Spleen Transport, 脾俞 pí shù), BL-23 (Kidney Transport, 肾俞 shèn shù), and CV-4 (Pass Head, 关元 guān yuán); needle with supplementation and moxa; also, moxa CV-8 (Spirit Gate Tower, 神阙 shén què).

Yīn vacuity and blood depletion (阴虚血亏 yīn xū xuè kuī) causes difficult defecation with dizzy head and flowery vision, heart palpitation, insomnia, dry mouth and throat, and somber-white facial complexion. In some cases, there is postmeridian tidal heat with reddening of the cheeks. The tongue is red with little fur and the pulse is fine and rapid.

Medicinal therapy: When blood vacuity is prominent, nourish the blood and moisten the intestines to free the stool. Use Blood-Boosting Intestine-Moistening Pill (益血润肠丸 yì xuè rùn cháng wán) plus flowery knotweed (Polygoni Multiflori Radix, 何首乌 hé shǒu wū) and black sesame (Sesami Semen Nigrum, 黑脂麻 hēi zhī má). If yīn vacuity is prominent, nourish yīn and engender liquid. Use Blood-Boosting Intestine-Moistening Pill (益血润肠丸 yì xuè rùn cháng wán) combined with Humor-Increasing Decoction (增液汤 zēng yè tāng).

Acumoxatherapy: Base treatment mainly on back transport points, SP, ST, and KI. Select BL-17 (Diaphragm Transport, 膈俞 gé shù), BL-20 (Spleen Transport, 脾俞 pí shù), BL-21 (Stomach Transport, 胃俞 wèi shù), BL-25 (Large Intestine Transport, 大肠俞 dà cháng shù), ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), CV-4 (Pass Head, 关元 guān yuán), SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), KI-3 (Great Ravine, 太溪 tài xī), and KI-6 (Shining Sea, 照海 zhào hǎi); needle with supplementation.