CONSTIPATION
Lee Chong Leng
1
CONTENTS
1)
Introduction
3 - 7
2)
Causes
8 -12
3)
Clinical Manifestations
13 - 20
4)
Diagnosis and Evaluation
21- 22
5)
Treatment with Tuina Therapy
23 - 45
6)
Cautions
46 - 47
2
CONSTIPATION
Varying bowel movementpattern
Discomfort with irregular ordifficult bowel movement
Dry, hard stools
3
THEDIGESTIVESYSTEM
4
THE BOWEL IN THE BODY
5
CONSTIPATION
Dry stools that causes
Difficulty defecation
Prolonged defecation
Unsmooth defecation
It may occur alone or may becomplicated with other diseases
6
CONSTIPATION
1) Acute constipation:
Begins suddenly andconspicuously
2) Chronic constipation:
May begin gradually andpersist for months or years
7
CAUSES OF CONSTIPATION
Dysfunction of the largeintestine :
retention of feces in theintestines
excessive absorption offluid in the stool
8
BRISTOL STOOL CHART
9
CAUSES OF CONSTIPATION
Not eating enough fiber or drinkingenough fluid
Irregular toilet habits
Certain medical conditions
Medicine taken for other illnesses
Pregnant women
10
CAUSES OF CONSTIPATION
Withhold stool and theintestines reabsorb thewater in the stool
Withhold stool when oneis not comfortablehaving a bowelmovement
11
CAUSES OF CONSTIPATION
Old people:
Age-related changes in the largeintestine
Increased use of drugs
Low-fiber diet
Reduced physical activity
Slowed transit during periods of illness
Enlarged rectum with age
12
CLINICAL MANIFESTATIONS
Dry stools
Difficulty in defecation
Normal frequency of defecation withdry feces
Difficulty in defecation in spite ofdesire to discharge
13
CLINICAL MANIFESTATIONS
Prolonged constipation will lead to
Abdominal distension
Stomachache
Vertigo
Anorexia
Uncomfortable sleep
Hemorrhoids and anal fissure
14
CLINICALMANIFESTATIONS BASEDON SYNDROMEDIFFERENTIATION
15
(1) HEAT ACCUMULATION INSTOMACH AND INTESTINES
Dry stool, fullness in the abdomen
Flushed face, warm feeling in thebody
Restlessness, foul breath, dry mouth,sores on lips
Red tongue with yellow or dry yellowcoating
Slippery and forceful pulse
16
(2) STAGNATION OF QI
Constipation without dry feces,abdominal distension involving thehypochondrium
Frequent belching, poor appetite
Mental depression, irritability,restlessness
Thin whitish tongue coating
Taut pulse
17
(3) DEFICIENCY OF QI ANDBLOOD
1) Due to Qi deficiency:
Difficult defecation, weakness todefecate, defecation without dry feces
Profuse sweating and short breath
Pale tongue with thin, whitish coating
Weak and soft pulse
18
(3) DEFICIENCY OF QI ANDBLOOD
2) Due to blood deficiency:
Dry stool
Grayish complexion
Vertigo, palpitation
Pale tongue
Thin pulse
19
(4) STAGNATION OF YIN COLD
Difficult defecation
Pale complexion
Cold limbs, cold pain inabdomen, soreness andcold on the back
Profuse and clear urine
Pale tongue with whitishcoating
Deep and slow pulse
20
ESSENTIALS FOR DIAGNOSIS
1)Defecation is prolonged once everytwo or more days
2)Dry stool like nuts accompanied byabdominal distension, lassitude andpoor appetite
3)Rule out intestinal organic diseases
21
EVALUATION ON CONSTIPATION
For new case, check on the changein diet or physical activity or new useof a drug
Perform blood tests to check for anunder-active thyroid gland(hypothyroidism) or high calciumlevels in the blood (hypercalcemia)
Possible cause due to cancer, acolonoscopy is performed
22
TREATMENT WITH TUINA THERAPY
Principle:
Regulating intestine and Qi to promotedefecation.
23
ACUPOINTS
ABDOMEN
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
24
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 pushingmethod
Rub the abdomen clockwise with thepalm
25
26
Zhongwan (中脘)，Tianshu (天枢)，Qihai (气海)
27
Daheng (大横)
OPERATION
The patient in prone position
Rub gently along the bilateral side of thespine 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
28
29
Geshu (膈俞)，Ganshu (肝俞)，Pishu (脾俞)，Shenshu (肾俞)
30
Shenshu (肾俞)，Dachangshu (大肠俞)
31
Baliao (八髎)
32
Changqiang (长强)
TREATMENT BASED ONSYNDROMEDIFFERENTIATION
33
(1) HEAT ACCUMULATION INSTOMACH AND INTESTINES
Rub horizontally Baliao 八髎 until it iswarm inside
Press and rub Zusanli 足三里 (ST 36)and Dachangshu 大肠俞 (BL 25) untilaching and distending feeling is felt
34
35
Zusanli (足三里)
(2) STAGNATION OF QI
Press and rub Zhongfu 中府 (LU 1),Yunmen 云门 (LU 2), Shanzhong 膻中 (CV17), 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) untilaching and distending feeling is felt
Rub horizontally backward and forwardthe chest until it is warm
Rub backward and forward obliquelythe hypochondriac region until itbecomes slightly warm
36
37
Zhongfu (中府)，Yunmen (云门)
38
Shanzhong (膻中)
39
Qimen (期门)，Zhangmen (章门)
40
Dazhui (大椎)，Feishu (肺俞)
41
Geshu (膈俞)，Ganshu (肝俞)，Pishu (脾俞)，Shenshu (肾俞)
(3) DEFICIENCY OF QI ANDBLOOD
Rub the upper part of the chest, theleft back and Baliao 八髎 points insacral region until it is warm
Press and rub Zusanli 足三里 (ST 36)and Zhigou 支沟 (TE 6)
42
43
Zhigou (支沟)
(4) STAGNATION OF YIN COLD
Rub horizontally the shoulder, backregion and Shenshu 肾俞 (BL 23),Mingmen 命门 (GV 4) and Baliao 八髎points in the lumbosacral region untilit is warm
Rub vertically the governor vesseluntil it is warm
44
45
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 exercisesto strengthen the abdominal muscle
4)Develop a regular toilet habit
5)Get plenty of rest
46
47
THANK YOU
48