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CONSTIPATION
Lee Chong Leng
1
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
19
(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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