1. CONSTIPATION Lee Chong Leng 1

2. CONTENTS 1)Introduction3 - 73 - 7 2)Causes8 -12 3)Clinical Manifestations13 - 20 4)Diagnosis and Evaluation21- 22 5)Treatment with Tuina Therapy23 - 45 6)Cautions46 - 47 2

3. CONSTIPATION  Varying bowel movement pattern  Discomfort with irregular or difficult bowel movement  Dry, hard stools 3

4. THE DIGESTIVE SYSTEM 4

5. THE BOWEL IN THE BODY 5

6. CONSTIPATION Dry stools that causes  Difficulty defecation  Prolonged defecation  Unsmooth defecation It may occur alone or may be complicated with other diseases 6

7. CONSTIPATION 1) Acute constipation:  Begins suddenly and conspicuously 2) Chronic constipation:  May begin gradually and persist for months or years 7

8. CAUSES OF CONSTIPATION Dysfunction of the large intestine :  retention of feces in the intestines  excessive absorption of fluid in the stool 8

9. BRISTOL STOOL CHART 9

10. CAUSES OF CONSTIPATION  Not eating enough fiber or drinking enough fluid  Irregular toilet habits  Certain medical conditions  Medicine taken for other illnesses  Pregnant women 10

11. 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 11

12. 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 illness  Enlarged rectum with age 12

13. CLINICAL MANIFESTATIONS  Dry stools  Difficulty in defecation  Normal frequency of defecation with dry feces  Difficulty in defecation in spite of desire to discharge 13

14. CLINICAL MANIFESTATIONS Prolonged constipation will lead to  Abdominal distension  Stomachache  Vertigo  Anorexia  Uncomfortable sleep  Hemorrhoids and anal fissure 14

15. CLINICAL MANIFESTATIONS BASED ON SYNDROME DIFFERENTIATION 15

16. (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

17. (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

18. (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

19. (3) DEFICIENCY OF QI AND BLOOD 2) Due to blood deficiency:  Dry stool  Grayish complexion  Vertigo, palpitation  Pale tongue  Thin pulse 19

20. (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 20

21. 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 21

22. 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 22

23. TREATMENT WITH TUINA THERAPY Principle: Regulating intestine and Qi to promote defecation. 23

24. ACUPOINTS ABDOMENBACK 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

25. 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 25

26. 26 Zhongwan ( 中脘 ) ， Tianshu ( 天枢 ) ， Qihai ( 气海 )

27. 27 Daheng ( 大横 )

28. 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 28

29. 29 Geshu ( 膈俞 ) ， Ganshu ( 肝俞 ) ， Pishu ( 脾俞 ) ， Shenshu ( 肾俞 )

30. 30 Shenshu ( 肾俞 ) ， Dachangshu ( 大肠俞 )

31. 31 Baliao ( 八髎 )

32. 32 Changqiang ( 长强 )

33. TREATMENT BASED ON SYNDROME DIFFERENTIATION 33

34. (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 34

35. 35 Zusanli ( 足三里 )

36. (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 36

37. 37 Zhongfu ( 中府 ) ， Yunmen ( 云门 )

38. 38 Shanzhong ( 膻中 )

39. 39 Qimen ( 期门 ) ， Zhangmen ( 章门 )

40. 40 Dazhui ( 大椎 ) ， Feishu ( 肺俞 )

41. 41 Geshu ( 膈俞 ) ， Ganshu ( 肝俞 ) ， Pishu ( 脾俞 ) ， Shenshu ( 肾俞 )

42. (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) 42

43. 43 Zhigou ( 支沟 )

44. (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 44

45. 45 Shenshu ( 肾俞 ) ， Mingmen ( 命门 )

46. 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 46

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48. THANK YOU 48