Constipation and bowel problems

Constipation? How does Chinese medicine explain and treat this? How can you work out what to do about it?
Restroom for Constipation
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Constipation

Constipation? How does Chinese medicine explain this, and what you can do about it?

There are lots of excellent books on your bowels – I mention a few below, but none of those I’ve read explain it with a universal theory that you can apply to anything.

What theory? Well, it’s been around for 3000 years and it has helped a huge number of people make sense of their lives. You can apply it to your car, your work, your life and your bowels.

In fact, as regards your bowels it is really explicit.

So what’t the theory? It’s the theory of yin and yang. Click the link to read more about it, but on this page I’ll show you how it helps you to understand what your bowels are doing!

It’s not just a theory, of course! It helps you understand what to do.

(By the way, this page is not complete. I add to it when I have time.)

Types of Constipation

Let’s list the main kinds of constipation. You could even have several kinds together:

  • Infrequent stools. What is infrequent? Opinions vary, but ideally you should pass stools at least once a day
  • Big stools, hard to pass.
  • Dry stools
  • Wet, runny or loose stools that you can’t expel easily
  • Stools made up of lots of little bits, often compacted together, like sheep stools or small stones.
  • Long thin stools, almost like pencils
  • Explosive stools, probably mainly liquid
  • Painful stools, meaning they cause pain when you produce them
  • Constipation with pain in your abdomen
  • Stools that make you cramp after passing them.
  • Exhausting stools, meaning they take a huge effort to pass – you might even need to rest after passing them!
  • Their smell! Strong smell, or almost NO smell.
  • Their colour! Pale/white; dark; yellow; green; bloody.
  • Stools that cause distension and are hard to shift, but when they do arrive, they look normal or nearly normal

A Bit of Theory about Constipation

 

We live in an era of information overload. So much knowledge, yet we often don’t know where to start, and once we get into it we get confused. 

 

Photo by Markus Spiske on Unsplash

What if there were a theory that helps you burrow down to the essentials of a situation? A theory you can use again and again?

Wouldn’t that be worth learning?

Yang processes

Yang processes are heating, moving, drying and pushy. Because they are heating, they can be smelly. Yang often appears as Qi, energy, moving things along, or changing things.

When yang is excessive, you get signs of heat, which means a strong odour, dryness, possibly thirst, even a rash. Also, with excess yang, you’ll probably be irritable. Urine will be darker than usual, and your breath may smell foul. Check your pulse, and with excess yang it’s probably fast. Read more under yang excess.

When yang is deficient, you get signs of cold, inaction and a lack of peristalsis, the rhythmic movement in the walls of your intestines that gently nudges what you’ve eaten onward, churning it slowly so that it all gets exposed to the walls of your bowels where nutrition can be extracted, eventually to enter your blood. For more in general about this, click on yang deficiency.

With deficient yang, you’ll probably be listless, aimless or indifferent.

Yang deficiency can seem rather like yin excess, but there are important differences, explained below.

When Qi gets blocked, you get what is called Qi stagnation. Then things don’t move smoothly through your intestines, or only bit by bit. Often there is pain, somewhat cramping or tightening.

Yin processes

Yin processes are cooling, slowing, moisturising and lethargic. As they are cooling, they have less, or no smell. Yin often works in the form of Blood, nourishing and repairing.

If yin is excessive, you get coldness, slowness and lethargy. Things build up and block you up. But when the stools finally arrive, they aren’t smelly, and may even be on the liquid side – but without much  odour. Check Excess Yin.

If yin is deficient, you get a low-grade heating process, making you a little dry-mouthed or thirsty: but this ‘thirst’ is easily slaked by a few sips of water, or something cold in your mouth. Also, the ‘heat’ can in time make your stools drier and harder to shift, but even so, without much odour. For more in general about this, click on yin deficiency.

Now let’s apply the theory of yin and yang …

Dry, infrequent, stools which may be sore to pass

As they are dry, probably you have too much yang: excess yang.

However, just possibly you could get dry stools with deficient yin, so how would you know?

Excess Yang-type stools

With excess yang, you’ll often feel hot in yourself, often thirsty – for lots of water/liquid, your urine will be dark and reduced in quantity, your mouth dry and close friends may tell you that your breath is strong, if not foul. Being a hot person, your face may be red. If you’ve had this for a while, your abdomen will hurt until you can pass the stools.

Your skin may smell.

Younger people tend to have excess yang.

To confirm this state of excess yang, check your tongue and pulse. Your tongue will be red and may be covered in a yellow fur, and your pulse will be faster than normal.

Pulse Taking on Left Wrist

Treatment for yang-type dry stools

There are two parts to the treatment. Some you can do yourself, but this usually needs treatment from a professional, unless you resort to over the counter solutions.

The underlying problem is that your body is generating too much heat. This could come from an inherited constitution, but more likely comes from a pattern of behaviour that encourages the creation of heat.

You should do something about this, because otherwise your excess-yang-type dry stools constipation will keep recurring, and you’ll keep taking over the counter remedies for it. Eventually these may cause suppression (click the link to read more about suppression.)

What should you do to reduce this tendency?

  • Eat less hot-type food. Click on the link to see which foods are more heating, in other words, which foods you should reduce.
  • Drink more water and less alcohol, and less cola, for example.
  • Reduce coffee and caffeine type drinks. Though they may keep you awake, they are heating. Black or green tea is less heating.
  • Eat more cold-type foods and drinks. Include lots of probiotics eg natural, unsweetened, unpasteurised, organic kefir or yogurt, both of which are cooling.
  • Chew food thoroughly before swallowing it.
  • Adopt a less stressed lifestyle. (Yes, I know, easier said than done.) Perhaps more yoga, meditation, tai chi: slow, stretching movements? ,,, And less hard competitive sports, less sudden jerking movements.
  • If you allow yourself to become angry and tense, frustrated, indignant, and aggressively pushy all the time or too often, this will generate heat in your system. That kind of heat you don’t want. So you must alter your behaviour. If this is difficult, see a counsellor … or an acupuncturist!
  • Acupuncture and herbs have excellent ways to help you reduce excess yang.

Deficient yin-type stools

But what if your dry stool constipation come from deficient yin?

Firstly, you are probably older, even elderly. But even if not older, your thirst will be much less obvious: probably just the desire to take a few sips regularly: certainly not a whole pint-sized glass, which excess yang likes.

Yes: you may have a dry mouth and throat, but this tends to worsen through the day, being at its worst in the evening. And it’s in the afternoon that you get most of your sore back pains, possibly even knee pain. Because this is yin deficiency, you won’t feel very stable and may get dizzy.

Several other symptoms point to yin deficiency: sore back mainly in the lumbar area (also called the small of the back, opposite your navel) and noises in your ears – a kind of hissing, called tinnitus.

At night, you may sweat in your sleep, and it could be copious and embarrassing.

What about your tongue and pulse with this type of constipation? 

Your tongue, in yin deficiency, is often bare ie without any coating or fur on it, and it may contain many cracks. Or it may be bare in patches, where it looks raw. In between the bare patches you may see fur or a coating that isn’t strongly rooted in the tongue surface.

Treatment for deficient-yin dry stools

Because you lack yin, and you probably got like this over a long period of time, either as you grew old or as you over-worked, this deficient-yin dry stool constipation takes a while to get better.

If you can get some good treatment, say herbs or acupuncture, you may improve faster, but if this isn’t possible, for this constipation you’ll need to consider the following:

  • Lots of rest and good, refreshing sleep
  • The right food, at the right way. That means lots of green vegetables, cooked and eaten warm and well-chewed really thoroughly before swallowing. To help you digest it well, add root ginger to your diet.
  • To persuade the trapped stools to move, you should walk lots. The movement in your abdomen from internal  muscles helps to massage the intestines, encouraging them to move the stools. Walking is probably better than cycling for this to work.
  • Massage may help to move your stools. If your condition is advanced, get a colonic irrigation to get movement stared.
  • Increase the amount of water, warm, with a slice of root ginger soaked in it, that you drink.
  • For more general advice on this, click on yin deficiency, or read my book on the subject.

Stools made up of lots of little bits, often compacted together, like sheep stools or small stones

With this kind of constipation your bowels don’t push through the stools smoothly. Instead they tighten up, letting through small packets which can look like rabbit poo or sheep faeces. 

When it emerges the stool can look as if all these pellets, or pebbles – depending on size – have been compacted together. Sometimes they emerge not lumped together but just one pebble after the next.

When your body feels stressed, or threatened in some way (and you may or may not be aware of the cause), the yang tightens up, like bracing itself against a shock. This blocks the natural steady yin flow of the stools.

These are called Qi stagnation stools.

What are the typical bowel symptoms of Qi stagnation?

Tension - a sign of stress
Rope tension – Photo by Aditya Wardhana on Unsplash
  • Stools like little stones or pellets
  • You definitely feel the urge to stool, but your body doesn’t easily let you do it to order
  • Your abdomen feels distended, stretched, tight – almost as if bursting, either all over or in one area
  • The pebble-like stools are not usually dry, unless you have had Qi stagnation for a long time, causing heat, which dries them out.
  • You are probably easily irritated though I doubt if you’ll admit this!
  • You may have wind – flatulence – going down, and it may have a strong smell
  • Belching
  • You may get a burning or cramping pain somewhere along the path of your large intestine. For example this could be near the beginning of the large intestine in the right hand lower corner (seen from where you look!)
  • Pulse: the typical Qi stagnation pulse is called ‘wiry’.
  • Tongue: often no strong indication, although there may be teeth-marks on the sides, or the sides may be a bit redder than the rest of the tongue

 

Find out more about this by clicking on Qi Stagnation, of which there are many kinds, so many that I wrote a book about it.

Cause of Qi Stagnation stools

There are several causes for Qi stagnation constipation, but by far the most common is emotional. This arises because, living in a civilised manner, we have to control the emotions we feel: we can’t let them all out, all the time. So we push the emotions down, inside, and – in Chinese medical parlance – this stops the free flow of Qi.

That Qi has to go somewhere, and it manifests where it isn’t wanted by seizing up your intestines, tightening up where normally your parasympathetic nervous system should relax. In time, you get IBS!

The most common emotions associated with this are anger and frustration, and this could happen where you have targets to meet and not enough time to achieve them – so you are always racing against time in a threatening situation beyond your control. This emotional situation has to continue for some time, possibly years, before it appears physically.

How long this constipation takes to appear depends on your underlying health.

Stop-start situations could also produce this, even if you enjoy them. For example, people doing competitive gaming on their consoles are frequently in an excited, tense mood, which varies between elation and despair. People trading on the stock-market on an hourly basis can be like this too.

So over-excitement, anxiety, elation, anger, frustration, fury, fear and sorrow, if they occur frequently or in quick succession in your life, may produce Qi stagnation.

Also, working assiduously in a job you dislike might produce it. 

Other causes?

These include some forms of medication, drugs, and injury or trauma. But the usual cause is emotional.

You make yourself more susceptible to Qi stagnation constipation stool problems if your diet is poor, lacking vegetables and fibre, and too full of stimulants like coffee.

Regular nutrition, with ‘good’ foods, properly chewed in an unhurried way, greatly strengthens your resistance to this form of constipation. Lots of cooked green vegetables, chewed well, may help!

 

Treatment for Qi Stagnation stools

1/ Treatment:

Acupuncture and Chinese herbs are really effective for Qi stagnation constipation

2/ Exercise

Regular exercise that gets you physically out of breath by making you move your body (walking, running, cycling swimming, tennis, weight-lifting, …) is a powerful way to move the Qi that has stagnated. In the West and in ‘developed’ countries, many of us no longer have to work physically to wash our clothes and dishes, walk to find water, run to chase our quarry, toil to sow the seeds for next year’s harvest. In countries where people have to work physically to survive, Qi stagnation constipation is comparatively rare.

Although vigorous exercise as explained is the priority, you must also start to learn to relax your body deeply when you aren’t exercising: yoga and Tai Chi are good. So is meditation, but you have to keep at it.

3/ Food

Proper food, not pre-processed, eaten regularly, chewed properly in a relaxed conducive manner …! Don’t eat when rushed, or at work, or on the run, or when angry, or with people who make you anxious or fearful or stressed. Treat your digestion like a cow: give it regular good food, give it plenty of time to digest it, don’t upset it and you’ll get wonderful milk and cream. (Apologies to vegetarians – this is my experience, having grown up on a dairy farm.)

Avoid or reduce caffeine and other stimulants which stimulate yang energy. This would be great, but your yang energy is already tightened up and more yang  – as from stimulants – will make it worse.

4/ Drugs and medication

Keep off social drugs and alcohol though a little of the latter may help. But it’s hard to take just a little, and you quickly move to the situation where your body produces Heat in your Liver as it processes the alcohol. The Heat dries the faeces, making them harder to shift, compounding your constipation.  (What’s a little amount of alcohol, I once asked the Chinese doctor whose clinic I was working in. After some thought he said – about a teaspoon of wine!)

Similarly, prescribed medication may worsen Qi stagnation, again because your liver has to process the medication, causing Heat. For more on this, click on Heat.

There are many other solutions to this, see my book on Qi Stagnation.

5/ Life situation

Important: if you cannot avoid an ongoing life situation that you suspect is causing your Qi stagnation constipation, whether at home or at work, I urge you to seek help, either from a Counsellor or, for example, an acupuncturist trained in traditional acupuncture. Ultimately you must change your situation somehow to make life less stressful – or your Qi stagnation constipation will worsen or recur.

Qi Deficiency stools

Qi is a form of Yang. In the West we translate it as ‘energy’ but the concept of Qi is bigger than that.

When you have a deficiency of Qi, this is what happens:

Fatigue is a result one Stomach and Spleen qi deficiency
Photo by Adrian Swancar on Unsplash
  • Tired – you feel exhausted, tired out
  • Although you have a sensation of need to open up your bowels and pass some stools, your body won’t do it, or it’s very difficult – and exhausting
  • So you feel even more exhausted after passing stools
  • Your stools, with qi deficiency, are usually long and thin, almost like a flexible pencil, but moist, not dry
  • Face is pale
  • You crave sweet food
  • Tongue: its colour is pale
  • Pulse: ’empty’

Why do you get Qi deficiency stools?

There are two main reasons:

  1. Spleen Qi deficiency
  2. Lung Qi deficiency

Spleen Qi deficiency comes with a poor appetite and general feeling of tiredness, especially muscular tiredness. For example, your thigh muscles really ache after walking, and even more so if climbing.

Lung qi deficiency constipation occurs with a weak voice and shortness of breath. You cannot talk for long without needing to rest, and your voice grows weaker as you continue to speak. Any exertion makes you puff, and you often need to stop to catch your breath during exercise.

You also like sweet food, but sometimes prefer it slightly spicy.

Between these two descriptions you can see some similarity, and of course they often occur together.

Spleen deficiency comes on when the Spleen is challenged.

Lung qi deficiency occurs after any severe or long illness, (especially if respiratory); as you grow older; in women soon after childbirth; in people who grieve for too long.

Treatment of Qi deficiency constipation

If you are unable to find good treatment for Qi deficiency constipation, then recovering will take time. The right treatment, however, can be very effective. 

For example, after a respiratory infection many years ago, I had all the symptoms of Lung Qi deficiency.

Of course, when you’re ill, you don’t necessarily look at yourself objectively and it took me around 10 days to work out what was the matter. When I realised what the matter was, and took the right herbs, I recovered completely within 24 hours. People were surprised! So was I!

Doing yourself? Here are some suggestions to remedy Qi deficiency:

  1. Rest often through the day
  2. Sleep long at night.
  3. Eat unprocessed food, preferably organic.
  4. Eat small meals more often. Avoid big meals.
  5. Never eat cold food or drink cold drinks. Always WARM.
  6. Add ginger to your diet, chopped up
  7. Chew everything well
  8. When eating, do so without interference from work, or even work colleagues. Don’t read and eat. Don’t rush food. Changing these food habits takes practice! And perseverance.
  9. Although you crave sweet food, it’s usually better not to eat much of it. Instead, look for foods that are gradually digested. Look for complex carbohydrates, chewed well, and warm wherever possible. These include root and green vegetables, and bread made from rye; porridge made from oats.
  10. Fresh air is important, but just to do deep breathing in it. No need yet for vigorous exercise if you’re qi deficient!
  11. As you will appreciate, if you have Spleen qi deficiency constipation, you won’t be hungry so you won’t want to eat the foods mentioned. That’s why acupuncture can really speed things up!

 

If you have been storing a large amount of stools, as your Qi improves, expect some large bowel motions.

The Effect of Cold ie Yin

Cold can cause constipation
Cold! Ice!
 

As explained, Yin factors are slow, regenerative, take time and lack heat.

You can be too yin in several ways.

  • From eating too many raw or cold-type foods. Both take more energy from you body to digest them. If you are young and/or vigorous, eating raw or cold foods won’t be a problem, but as you age, or during or after an illness, shock, accident, over-exertion and sometimes from overworking your body is exhausted and lacks the heat resources it needs to digest your food properly.
  • If you have been  exposed to cold. This could be cold weather or getting cold suddenly, perhaps from a cool draft, when you weren’t wearing enough to keep you warm. In other words, you yang supplies were overwhelmed by a yin factor – cold.
  • This cold exposure is more likely to be a cause if your abdomen was exposed.

 

Cold in Large Intestine stools

  • Stools are loose, moist, and rather like duck droppings
  • You get pain in your abdomen: you like holding it, like warmth on it, prefer sitting to standing
  • With this type of constipation you feel tired 
  • You feel cold, eg legs, feet, arms, hands
  • Your abdomen makes lots of noise, mainly of rumbling, the technical name for this is ‘borborygmi’.
  • If you pass wind (downwards, also known as ‘farting’) it won’t have much smell – but as you do it you may fear loss of some of your stools: the sensation that they could fall out involuntarily. Which, be warned, they might.
  • You may be anxious about being too far from a toilet, for fear of diarrhoea-type accidents.
  • You probably feel a bit depressed, even sad, and anxious. You are more likely wish to be alone.
  • Tongue: its colour will be pale, and its coating, if any, may be thin and pale, or even colourless.
  • Pulse: weak and deep, which means you must press deep to find it.

 

This is a deficiency syndrome, meaning that it occurs because your body lacked the means to resist it. That means that somebody else, more vigorous than you, might not have developed the symptoms, as compared with you in that situation!

Some stomach bugs can behave like this, producing cold stools of this kind, and it can be hard to tell the difference between cold from exposure or cold from cold foods, and cold from a bug, except by considering how the condition began.

(This constipation condition is somewhat similar to another, much stronger, set of symptoms, also caused by Cold, see next below.)

This symptom is very nearly the same as another called Spleen Yang deficiency.

Jonathan Brand colours

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