Examine Your Stool (3)

tutor

[b:9075f6d6e8]Examine Your Stool[/b:9075f6d6e8]
Normally, an individual is able to defecate once or twice per day without straining. The stool should neither be too hard nor too soft, and should not have a foul odor. There also should be no pus, blood, mucus or undigested food in it. A TCM physician usually notes the frequency, form and color of the stool as well as the accompanying feelings during the bowl movement.

[b:9075f6d6e8]Nature of stool [/b:9075f6d6e8]
· An offensive odor of stool pertains to heat accumulation.
· Dry, dark-brown stool means excessive heat is present in the large intestine.
· Loose stools with a fishy odor pertain to excessive cold in the intestines.
· Extremely dry and hard stool is often seen in a deficiency of blood or body fluids.
· Loose bowels with shapeless stool usually are due to deficiency cold in the spleen and stomach.
· Initial discharge of a hard stool and then discharge of a loose stool can be seen in dampness accumulation caused by a spleen deficiency.
· Alternate dry and loose stool in irregular patterns are due to disharmony between the liver and spleen.
· Stools with partly digested food and a rotten odor are caused by improper food intake, which leads to food retention. Individuals will also pass excessive gas.
· Stools containing completely undigested food are due to kidney yang exhaustion.
· Stools with yellow mucus accompanied with tenesmus (rectal heaviness) means damp-heat has accumulated in the large intestine.
· Pus and bloody stools are seen in dysentery.
· Sour stools in children are due to food retention without proper digestion.
Improper food intake leads to food retention; individuals may also pass excessive gas.

[b:9075f6d6e8]Constipation[/b:9075f6d6e8]
Constipation refers to infrequency or difficulty in defecation and may be accompanied with dry or hard stool. In TCM, this is usually due to heat accumulating in the intestines or insufficient amounts of body fluids. This leads to the intestines being unable to perform peristalsis (special movements of the intestines by which the contents are moved along the cavity). TCM categorizes the condition into four types:

Heat type: This is caused by excessive heat consuming the body fluid making the content in the bowel unable to flow freely. Individuals defecate dry or hard stools. Other accompanying symptoms are a flushed face, low-grade fever, thirst, foul breath, abdominal fullness and abdominal distention with pain that does not go away with pressure placed on the abdomen.On examination, the tongue is red, covered by a yellow dry fur; the pulse is rapid.

Cold type: Individuals have difficulty in defecation with dry or normal stool texture. Other symptoms include abdominal distention with pain that does not go away with pressure placed on the abdomen, a pale complexion, cold limbs, an aversion to cold temperatures and a preference to drink hot beverages.On examination the tongue is pale, and the pulse is deep and slow. This is a pattern of cold evil invasion that results in depression of the yang qi and obstruction of the bowel's qi.
Qi type: The individual presents with constipation or difficulty in defecation even though he or she has an urge. The usual associated symptoms are fullness in the chest and rib sides, frequent belching and a poor appetite.On examination, the tongue is covered by thin and greasy fur; the pulse is taut.

Deficiency type: Individuals have an urge to defecate but it is difficult, and, many persons will try forceful straining to release the stool. In some cases, extremely dry hard stools like sheep feces are discharged. Other usual symptoms are a pale complexion, dizziness and fatigue.On examination, the tongue is pale; the pulse is fine and hesitant. This is a pattern of insufficiency of the blood and body fluids, or, it is due to deficiency of both qi and yin. It is often seen in chronic disease states, in the elderly and women who have just given birth.

[b:9075f6d6e8]Diarrhea[/b:9075f6d6e8]
Diarrhea means frequent defecation with loose or watery stools. TCM believes this symptom is mainly caused by an attack of exogenous evils, improper diet or yang deficiency in both the spleen and kidneys, which make water descend and cause dysfunction in the intestines. TCM divides the condition into the following six types:

·Damp cold type: Individuals present with diarrhea characterized by loose and watery stools. The stools are pale yellow and have a foul odor. Other accompanying symptoms are a bland taste in the mouth, fullness in the epigastric (the upper middle region of the abdomen), abdominal pain, intestinal rumblings and a poor appetite. There may be alternating chills and fever accompanied by headache, nasal congestion and general soreness.On examination, the tongue is covered by thick white fur; the pulse is slow and hesitant.

·Damp heat type: Individuals usually start with abdominal pain followed by diarrhea, and pass formless and foul odor stools with great frequency. Other symptoms include intestinal rumblings, restlessness, thirst and a burning sensation in the anus.On examination, the tongue is red and covered by yellow, thick and greasy fur; the pulse is rapid.
The tongue is red and coverd by yellow greasy fur.

·Food retention type: Individuals have foul smelling diarrhea with sour and rotten vomit, fullness of the epigastric region, intestinal rumblings, abdominal pain that is diminished after fecal discharge, a poor appetite and fever.On examination, the tongue fur is thick and greasy; the pulse is rolling. This is often due to eating unhygienic food or an improper diet.

·Spleen yang deficiency type: Individuals have diarrhea or may just pass loose and soft stool. There is undigested food in the stool. Other symptoms include poor appetite, increased stooling frequency after eating greasy foods, abdominal distention, a dull pain above the navel, a sallow complexion, fatigue and general weakness.On examination, the tongue is pale, enlarged and covered by white fur; the pulse is weak.
Poor appetite and abdominal discomfort are associated with a spleen disorder.

·Hyperactive liver qi attacking the spleen type : Individuals have abdominal pain and diarrhea following emotional disturbances. The abdominal discomfort will slightly diminish after defecation. Accompanying symptoms include fullness in the chest and rib sides, belching, loss of appetite, a bitter taste in the mouth, acid regurgitation, a sallow complexion and fatigue.On examination, the tongue is pink with little fur; the pulse is taut.

·Kidney yang deficiency type: This is due to the kidney yang failing to warm the spleen. Individuals present with abdominal pain at dawn and then pass a loose stool. The abdominal pain is relieved after defecation. There is also coldness and soreness present in the lumbar area and knees. Distension in the abdominal region and aversion of coldness are typically present.On examination, the tongue is pale and enlarged; the pulse is deep and fine.

[b:9075f6d6e8]Blood in the stool[/b:9075f6d6e8]
·Stool mixed with fresh blood and foul in odor is often due to an attack of heat evils in the meridians and blood vessels.
·Dysentery: Both blood and mucus are present in the stool. Other symptoms include abdominal pain, fever, tenesmus (rectal heaviness) and abdominal urgency. This is a result of damp-heat in the large intestine.
·Black, tar-liked stool is due to blood stasis, which indicates bleeding in the upper portion of the digestive system.
·Red, bloody stool indicates bleeding in the lower portion of the digestive system..
· Blood in the stool should always be evaluated by a physician as it can be a symptom of some serious medical conditions.

[b:9075f6d6e8]Fecal incontinence[/b:9075f6d6e8]
This occurs when an individual is unable to control defecation and the stool is discharged out spontaneously. It pertains to yang deficiencies in the spleen and kidneys.

tutor

Dear Symplex, it seems you have spleen deficiency!

symplex

Dear Tutor,

thank you very much for sharing this information. Often when I'm drinking coffe I feel immediatley the need to go to toilet and my stool is often than loose and fishy. Sometimes I have the same in drinking other warm fluids like tea or cold mineral water too; or when I get from a warm place into cold place (like to get into a heavy climatised building in hot sumer days) So I'm not sure is due to spleen and liver disharmony, or are my intestines too much sensitive against heat and cold, or what ..?
By the way on coffee it doesn't mather if it's hot or cold, the result is always the same So I do have constipation maybe only a few days in a year, where I use only to drink coffee as treatment...

tutor

Dear lit_hua_nia and Ed,
That's the reason I stressed the importance of combining all the four diagnostic methods, not only one method.
Possible the white-colored stool does mean the cold in large intestine, but we have to see all the other manifestations as well.
So the understanding of the deep yellow urine denoting the heat or damp heat syndrome is quite correct.

Yes, some books written by foreigners are not well translated or not well written, so there could be mistakes and that’s also why at the beginning the TCM practitioners in Europe or North America would think the traditional Chinese medicine in China is not in a traditional way, while they are doing the more traditional way of TCM, don’t you think it is a stupid idea?

To say the proverb, it is neither accurately translated, the original or the common understanding of this proverb is: “A conversation with you gentleman is better than ten years of study (education in school)”, of course the translation is not too bad, but not accurate.
This is usually the flattering way to highly evaluate the opinion of somebody who’s talking with you.
Ok, it’s not so easy to make good translation from one language to another.

Tutor

tutor

[quote="ed austin"]Dear Tutor:
To return to the question of what color the urine would be in case the stool is white - One of the posts above mentions that white stool is associated with cold in the Large Intestine meridian, so then I would expect the urine to be clear or light yellow, if it is a cold syndrome.
Thank you
Ed Austin[/quote]

Dear Ed Austin,
I found that information ("...pale, almost white stools indicate Cold in the Large intestine...") in a e-book written by one Italian author and I do not know how deep understanding of TCM he have. Many people in the West now write books on TCM by simply making compilations of various Chinese texbooks. And in these their compilations they often make a lot of mistakes.
So I do not even know, is it true or not what this Italian writes about.

tutor

Dear Tutor:

To return to the question of what color the urine would be in case the stool is white - One of the posts above mentions that white stool is associated with cold in the Large Intestine meridian, so then I would expect the urine to be clear or light yellow, if it is a cold syndrome.

Thank you

Ed Austin

tutor

Dear Tutor,
„Deep yellow urine can indicate heat accumulation“.
So I think that urine of dark-yellow color would be present in cases with heat, fire and damp-heat interior syndromes. The darker the color of urine will be, the more severe these syndromes will be.
And in contrary: “when the urine turns clear in febrile illnesses, it indicates an individual will recover soon”.


Yes, of course, the combination of all four diagnostic methods is very important.
Only it seems for me, that it is very, very difficult (or, perhaps even impossible) to learn pulse diagnosis via internet only, without enough long direct contact with both the real patients and the experienced teacher who will show the real different pulses on practice, and give his advice, and correct mistakes of pulse diagnosis of the student.
So, without good command of pulse diagnosis, instead of four diagnostic methods in practical use I will have only three of them. To compensate this shortage, it seems for me that it would be logical to learn deeper about the rest of the diagnostic methods.
The principle “difficult points should be learned by heart” will work when learning theory about pulses, but in this situation, it seems to me, will not help to learn pulses in practice.




[quote="tutor"]
...Confucius used to say "Learning without reasoning leads to confusion (or unclear in the concept); thinking without learning is wasted effort" What do you think of this remark?

Tutor[/quote]


It would be not wise not to agree with such high authority as Confucius.
By my opinion, learning - perhaps - is the process, which goes not in a straight ascending line but rather in a line, which is zigzag, which first goes some distance forward and, when you learn something new, then you all the time need to return some distance back and, from the basis of the newly acquired knowledge to reevaluate knowledge, which was obtained earlier. And because of this reevaluation, when there are more then one variant of possible answers, between which the student (because of his limited knowledge of the subject) cannot choose the right one, then he sometimes asks questions, answers to which, got from his teacher, help student to get a right view to the things and to feel standing on the firm ground.

P. S. On that site with Chinese proverbs, I found one more proverb: “A single conversation with a wise man is better than ten years of study”(Chinese Pinyin: Yu4 jun1 yi4 xi2 tan2, sheng4 du2 shi2 nian2 shu1 - I am not sure, is the translation good).
Who knows, who was the author of this proverb? May be he was also some high authority, whose name is forgotten now?

tutor

Dear lit_hua_nia
What do you think of the dark yellow urine?
What should it be in terms of traditional Chinese medical diagnosis?
As to the color of stool, I think we have to combine all the information from all the four diagnostic methods, not only the color of stool!!!
This is the view stated at the very beginning of the text of course B!

The greenish color of stool could be related with liver dysfunction, but it is hard to say that’s because of the excessive production of bile, it all depends on the comprehensive analysis of all the clinical data.
So I also think you do need to read carefully the details of the text first apart from asking questions.
I don't know the Chinese proverb you have just mentioned, it seems quite right, but Confucius used to say "Learning without reasoning leads to confusion (or unclear in the concept); thinking without learning is wasted effort" What do you think of this remark?


Tutor

tutor

Dear lit_hua_nia
What do you think of the dark yellow urine?
What should it be in terms of traditional Chinese medical diagnosis?
As to the color of stool, I think we have to combine all the information from all the four diagnostic methods, not only the color of stool!!!
This is the view stated at the very beginning of the text of course B!

The greenish color of stool could be related with liver dysfunction, but it is hard to say that’s because of the excessive production of bile, it all depends on the comprehensive analysis of all the clinical data.
So I also think you do need to read carefully the details of the text first apart from asking questions.
I don't know the Chinese proverb you have just mentioned, it seems quite right, but Confucius used to say "Learning without reasoning leads to confusion (or unclear in the concept); thinking without learning is wasted effort" What do you think of this remark?

Tutor

Last edited by tutor on Thu Nov 27, 2008 10:44 pm; edited 1 time in total

tutor

Dear Tutor,
The color of urine should be very dark-yellow in case of jaundice. Perhaps it is because that bile, which was released by the gallbladder to another parts of the body, needs another ways to escape out from the body. When it is impossible to escape with stool, the bile then escapes out with urine.
May be, that the part of the bile also can escape out with sweat?

Regarding to the various colors of stool, I have also a version, that in a case when liver produce too much bile (and when it is not a case of jaundice), than the stool will be of a greenish color? Of course, I do not know is it so or not?



P.S. Few days ago I found in Internet a lot of Chinese proverbs. One of them was this: “One who asks questions will be a fool for five minutes; one who not asks, will be a fool for entire his life”. So, before it will too late for me, I try to ask questions