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The process of diagnosing a morbid condition as a disease pattern of the large intestine.

Physiology Recap

The large intestine governs conveyance and transformation. It absorbs excess water from the stool and conveys it downward for discharge via the anus. Disease of the large intestine involves disturbances of these functions and manifests in abnormalities of stool, notably diarrhea and constipation.

Pathomechanical Features

Large intestine disease arises by the following pathomechanisms:

• dryness-heat binding internally;
• damp-heat accumulating and stagnating;
• vacuity cold arising internally;
• depletion of fluids.

The first two of these pathomechanisms result in repletion patterns, and the last two in vacuity patterns. All give rise to abnormalities of the stool.

Stomach and Large Intestine

Certain disease patterns of the stomach and large intestines overlap, namely cold stagnating in the stomach and intestines, food stagnation, and gastrointestinal qì stagnation.

Lung and Large Intestine

The lung and large intestine stand in exterior-interior relationship. Both like moisture and are averse to dryness. Both have a downbearing action. The lung’s depurative downbearing action helps the large intestine’s downward conveyance, and vice versa.

In pathology, the mutual influence of the lung and large intestine is mostly related to impairment of downbearing and to dryness, although it does not figure prominently in either lung or large intestine patterns.

• When exuberant lung heat scorches the fluids, disease of the viscus can spread to the bowel, causing repletion heat constipation.
• When large intestine repletion heat is severe, disease of the bowel can affect the viscus, impairing the downbearing of lung qì and causing oppression in the chest and rapid breathing.
• When impaired depurative downbearing prevents fluids from flowing downward to moisten the large intestine, constipation can arise.
• When lung qì is insufficient and depurative downbearing is consequently weakened, large intestine conveyance may be affected. This manifests in qì vacuity constipation.

Large Intestine Signs

Large intestine signs chiefly reflect abnormalities of stool and defecation.

Constipation (便秘 biàn bì): Constipation means much longer intervals between bowel movements than the individual considers normal. Although bowel habits vary considerably, failure to defecate for longer than normal (4–7 days or more) constipation in any individual. It occurs in intestinal heat bowel pattern; blood vacuity and liquid depletion; large intestine liquid depletion; kidney yáng vacuity; and stomach cold. Constipation in heat patterns is sometimes called heat bind, and in cold patterns, cold bind.

Diarrhea (泻泄 xiè xiè): Increased fluidity of stool and frequency of defecation. It differs from sloppy stool, which is increased fluidity without marked increase in frequency of defecation. Diarrhea is essentially related to dysfunction of the large intestine and/or the spleen and stomach. In large intestine disease, diarrhea occurs in large intestine damp-heat (which may stem from spleen dysfunction) and in large intestine vacuity cold. In intestinal heat bowel repletion patterns, it may take the form of heat bind with circumfluence (see next item). In spleen-stomach disease, it can occur in spleen vacuity qì fall, spleen-kidney yáng vacuity, liver qì invading the spleen, and food stagnating in the stomach and intestines.

Heat bind with circumfluence (热结旁流 rè jié páng liú): The passing of green-blackish foul-smelling water in the stool in patients suffering from heat bind, which is constipation caused by exuberant heat in the intestines (intestinal heat bowel repletion patterns). It is so called because the thin stool passes around the impacted stool.

Fecal incontinence (大便失禁 dà biàn shī jìn): Loss of voluntary control over bowel movements. It occurs in large intestine vacuity cold, spleen vacuity qì fall, spleen-kidney yáng vacuity. It can also occur in damp-heat or intense heat toxin patterns with clouded spirit.

Efflux diarrhea (滑泄 huá xiè): Persistent diarrhea with fecal incontinence. It occurs in large intestine vacuity cold.

Bloody stool (便血 biàn xuè): Also called blood in the stool. Loss of blood through the anus, with varying amounts of stool. Called hematochezia in biomedicine. Bloody stool is attributed either to the spleen failing to control the blood or to damp-heat pouring down into the large intestine and damaging the network vessels. Bright-red blood indicates heat, whereas dark-red blood indicates qì vacuity or damp toxin. See also the next item.

Pus and blood in the stool (大便脓血 dà biàn nóng xuè): The presence of blood and pus-like matter in the stool, usually accompanied by abdominal pain, frequent defecation, and tenesmus. It is a chief sign of dysentery.

Tenesmus (里急后重 lǐ jí hòu zhòng): Also called abdominal urgency and rectal heaviness. Urgent desire to defecate with a feeling of pressure in the rectum and difficulty expelling stool. It most commonly occurs in dysentery attributed to large intestine damp-heat but may also occur in qì stagnation, qì vacuity, and damage to liquid with blood vacuity.

Ungratifying defecation (大便不爽 dà biàn bù shuǎng): Absence of the normal feeling of satisfactory completion after defecation. It occurs in large intestine damp-heat and food stagnating in the stomach duct.

Large Intestine Diseases

The main large intestine diseases are intestinal welling-abscesses, intestinal wind, and cholera (sudden turmoil). Other large-intestine-related diseases include:

Intestinal welling-abscess (肠痈 cháng yōng): A welling-abscess forming in the intestines. It is attributed to blood stasis stemming from either damp-heat or qì and blood stagnation. Static blood obstructs the flow of qì and blood depriving the intestine of nourishment and thereby giving rise to putrefaction. An intestinal welling-abscess is marked by pain in the smaller abdomen (that is, lower abdomen) that refuses pressure. It corresponds in biomedicine to appendicitis, periappendicular abscess, and other suppurative abdominal lesions.

Cholera (霍乱 huò luàn): Also called sudden turmoil. A disease characterized by simultaneous vomiting and diarrhea, abdominal pain, and often followed by severe painful cramping of the calves. It is caused by contraction of dampness or by unclean food. It most commonly presents as damp-heat or cold-damp. It corresponds to cholera, paracholera, acute gastroenteritis, and bacterial food poisoning in biomedicine. Because the Chinese medical concept is wider than the biomedical understanding of cholera, which is specifically a disease caused by Vibrio cholerae, many prefer to call it sudden turmoil, the literal meaning of the Chinese term.

• Cold cholera: Simultaneous vomiting and diarrhea with stool and vomitus that has no pronounced odor and that is like water or the water in which rice has been washed. There may be abdominal pain, cold limbs, green-blue or purple lips and nails, and a pulse that is sunken and hidden. It is attributed to consumption of raw or cold foods or to external contraction of cold-damp.
• Heat cholera: Simultaneous vomiting and diarrhea with foul-smelling stool and vomitus, abdominal pain, and painful cramping of the calves. It is caused by dietary irregularities, summerheat or damp-heat.

Hemorrhoids (痔 zhì, 痔疮 zhì chuāng, 痔核 zhì hé): The protrusion of blood vessels on the inside or outside of the anus, often accompanied by constipation and the passage of fresh blood. Distinction is made between vacuity and repletion patterns, the latter being the more common.

• Vacuity patterns are caused by long sitting, standing, or walking, enduring dysentery or diarrhea, constipation and straining to defecate, or center qì fall in pregnancy.
• Repletion patterns are the result of damp-heat or dryness-heat and manifest in heat signs, such as constipation, reddish urine, thirst, red tongue and yellow fur, and a rapid pulse.

Intestinal wind (肠风 cháng fēng): (1) A disease marked by the passage of bright-red blood before stool (proximal bleeding), without pain or swelling of the anus and with a red tongue and rapid pulse. It is attributed to wind-heat or damp-heat in the stomach and intestines, in some cases complicated by dampness. (2) Internal hemorrhoids (poorly distinguishable from the first definition by traditional diagnostic techniques).

Dysentery (痢疾 lì jí): A disease characterized by tenesmus (urgency to defecate and straining) with blood and pus in the stool. Dysentery usually occurs in hot weather and arises when spleen vacuity and eating raw, cold, or unclean food allow damp-heat to arise and pour down to the intestines. When blood and pus (actually mucus) are equally prominent, it is called red and white dysentery. When blood is prominent, it is called red dysentery or blood dysentery, while when pus is prominent, it is called white dysentery. In the advanced stages, it may turn into a vacuity pattern characterized by fatigue and milder abdominal pain. This is called vacuity dysentery.

Large Intestine Patterns

Below is a brief description of the major stomach and large intestine disease patterns, with links to entries that provide more detail.

Gastrointestinal qì stagnation (肠胃气滞 cháng wèi qì zhì): Distension and scurrying pain in the stomach duct and intestines; belching; nausea and vomiting; rumbling intestines; passing of flatus. It is caused by anger and frustration; dietary irregularities; lack of exercise; or cold qì invading the stomach.

Intestinal heat bowel pattern (肠热腑证 cháng rè fǔ zhèng): Constipation; abdominal fullness, hardness, and pain; intense interior heat signs. It occurs in externally contracted disease when evil heat enters the yáng míng (yáng míng) (yáng míng) bowel (according to six-channel pattern identification) or the qì aspect (according to four-aspect pattern identification).

Large intestine vacuity cold (大肠虚寒 dà cháng xū hán): Efflux diarrhea (uncontrollable diarrhea) and fecal incontinence; vacuity cold signs. It mostly results from enduring diarrhea or dysentery that fails to be treated adequately.

Large intestine humor depletion (大肠津亏 dà cháng jīn kuī): A gradually developing condition in which the stool is dry and difficult to evacuate. It is attributable to numerous factors, including yīn depletion in advancing years; warm disease; external dryness; excessive vomiting; blood loss; childbirth; or bleeding hemorrhoids.

Large intestinal damp-heat (大肠湿热 dà cháng shī rè): Dysentery with pus and blood in the stool or fulminant diarrhea; abdominal pain; tenesmus; signs of damp-heat. It is caused by damp-heat brewing internally. It results from externally contracted damp-heat or from dietary irregularities.

Worms accumulating in the intestinal tract (虫积肠道 chóng jī cháng dào): Abdominal pain; yellow facial complexion; emaciation; passing of roundworm in the stool. It results from unclean food. See worm accumulation.

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