DIARRHEA Lee Chong Leng

CONTENTS 1) Introduction 4 2) Clinical Manifestations 10 - 15 3) Essentials for Diagnosis 16 - 17 4) Treatment with Tuina Therapy 18 - 42 5) Cautions 43

DIARRHEA May occur at any time, especially in summer and autumn Frequent and sloppy stool, sometimes even appearing like water Similar to intestinal inflammation, chronic enteritis, gastrointestinal neurosis and non-specific ulcerated colitis in Western medicine

DIARRHEA

CLINICAL MANIFESTATIONS 1. Acute diarrhea (1) Attack of dampness (2) Improper diet 2. Chronic diarrhea (1) Deficiency of spleen & stomach (2) Yang deficiency of kidney & spleen (3) Liver Qi over-straining the spleen

ACUTE DIARRHEA Attack of dampness Sudden onset with thin and loose stool or mixed with mucus, ten times a day Accompanied by abdominal pain, borboygmus, aching pain of the extremities, yellowish or whitish greasy tongue coating, soft or rapid and slippery pulse

ACUTE DIARRHEA Improper diet Sudden onset with a history of improper diet, diarrhea with rotten egg smell Accompanied by abdominal distension, foul belching, alleviation of pain after diarrhea, acid regurgitation, thick greasy tongue coating, soft or rapid slippery pulse

CHRONIC DIARRHEA Deficiency of spleen and stomach Usually occur after taking greasy, oily food, marked by loose or watery stool Poor appetite, pale tongue with whitish tongue coating, slow and weak pulse

CHRONIC DIARRHEA Yang deficiency of kidney and spleen Diarrhea accompanied by pain around the umbilicus occurring at dawn and right after borboygmus Pain is relieved after diarrhea Other symptoms include cold feeling in abdomen, aching and coldness in the waist and limbs, pale tongue with whitish coating, deep and thin pulse

CHRONIC DIARRHEA Liver Qi over-restraining the spleen Often induced by excessive emotional changes Accompanied by abdominal pain, borborygums, full sensation in the chest and hypochondriac regions, belching, thin tongue coating, taut and thin pulse

ESSENTIALS FOR DIAGNOSIS 1. Loose or watery feces, increased frequency, often abdominal distension 2. Sudden onset of acute fulminate diarrhea with short duration, aversion of cold and fever 3. Slow onset of chronic diarrhea with longer duration and frequent relapse and fluctuation

ESSENTIALS FOR DIAGNOSIS 4. Improper diet, cold attack or emotional changes that can lead to diarrhea 5. Red and white blood cells can be seen in stool test, the bacteria culture of stool is either positive or negative 6. Barium meal X-ray examination or intestinal endoscope should be done if necessary

Treatment with tuina therapy Principle: Invigorating the spleen and harmonizing the stomach, warming the kidney to strengthen yang, soothing the liver to regulate Qi

Treatment with tuina therapy Acupoint and location: Zhongwan (CV 12), Tianshu (ST 25), Qihai (CV 6), Guanyuan (CV 4) Pishu (BL 20), Weishu (BL 21), Shenshu (BL 23), Dachangshu (BL 25) and Changqiang (GV 1)

TREATMENT WITH TUINA THERAPY Operation 1: Patient - lateral recumbent position Push first gently and then strongly from Zhongwan (CV 12) down to Qihai (CV 6) and Guanyuan (CV 4) for 5-6 times Rub the abdomen counter-clockwise for about 8 minutes.

Zhongwan (中脘)，Tianshu (天枢)，Qihai (气海)

Guanyuan (关元)

TREATMENT WITH TUINA THERAPY Operation 2: Patient - prone position Roll from Pishu (BL 20) to Dachangshu (BL 25), 1 minute each Press Pishu (BL 20), Weishu (BL 21), Dachangshu (BL 25) and Changqiang (GV 1) repeatedly for about 3-4 times Rub the left side of the back until it is warm for about 10 minutes

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

Shenshu (肾俞)，Dachangshu (大肠俞)

Weishu (胃俞)

Changqiang (长强)

MANIPULATIONS ACCORDING TO SYNDROME DIFFERENTIATION

(1) COLD AND DAMPNESS Rub Shenque (CV 8), Qihai (CV 6) until the abdomen becomes warm Press and rub Zusanli (ST 36) and Neiguan (PC 6) for 1 minute each Rub the left side of the back and lumbosacral region till it turns warm

Shenque (神阙)

Zusanli (足三里)

Neiguan (内关)

Rub the abdomen clockwise (2) IMPROPER DIET Rub the abdomen clockwise

(3) GASTRICSPLENIC DEFICIENCY Rub Guanyuan (CV 4) and Zusanli (ST 36) gently for 2 minutes each Rub Qihai (CV 6) for a longer period of time Rub the whole abdomen anticlockwise, mainly focusing on the epigastric region Rub the lower abdomen clockwise

(4) YANG DEFICIENCY IN BOTH SPLEEN AND KIDNEYS Rub gently Qihai (CV 6) and Guanyuan (CV 4) for 3 minutes each Rub vertically the govern vessel on the back Rub transversely Shenshu (BL 23), Mingmen (GV 4) and Baliao

Mingmen (命门)

Baliao (八髎)

(5) LIVER QI OVER RESTRAINING THE SPLEEN Press and knead gently Zhangmen (LR 13) and Qimen (LR 14) for about 5-10 minutes Rub obliquely backward and forward hypochodrium region until it is slightly warm Rub Ganshu (BL 18), Danshu (BL 19), Geshu (BL 17), Taichong (LR 3) and Xingjian (LR 2)

Qimen (期门)，Zhangmen (章门)

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

Danshu (胆俞)

Dadun (大敦)，Xingjian (行间)，Taichong (太冲)

CAUTIONS 1. Abstain from starch and fat food, avoid food difficult to digest 2. Keep warm, avoid overstrain and pay attention to mental state and diet

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