By Tai Lahans
The colon and rectum constitute the distal end of the gastrointestinal tube. They are part of the fu aspect of the zang–fu. This hollow tube is within the body but its interior is actually outside of the body and acts as a conduit for the reception and extraction of nutrition from foods and water (outside). The lung and large intestine are coupled organs perhaps because they are the only two organs in the body that have such an interaction between the outside and the inside. As a result, they both must have a tissue type that allows the exchange of life-giving substances, oxygen (lung) and nutrition in the form of chyme (GI tube), between a mucosal barrier and the blood. This makes them at once delicate and strong. Protection against outside pathogens through Wei (protective) Qi and especially through Ying (nutritive) Qi is built into these organs and their relationship to the San Jiao, and is part of their commonality.
The colon is easily exposed to pathogenic factors. Some of these are endogenous, like bile acids formed from the breakdown of fats.82 Some are exogenous and include the microflora that the human body lives with over a lifetime beginning in early life as part of the natural and healthy exposures to certain bacteria that aid in digestion and constitute the maturation of the digestion in a young child around the age of 7–9.83
In terms of pathogenic unhealthy exposures to the colon, damp– heat and wind are the two main ones. Damp–heat can be synonymous with a diet high in animal fats, sugars, and refined foods that lead to spleen/pancreas injury, which can result in lower Jiao damp accumulations. Colonic polyps are a material form of dampness. They are like little mushrooms growing on the rainforest floor. Excessive mucus in the stools is another material form of dampness. It is a precursor to polyps and can occur alongside them. Wind pathogens refer to the anaerobic bacteria that evolve from the same diet. They also refer to chemical exposures that generally enter like a spreading fog as part of the food chain in contaminated food. Nitrites and nitrates are examples but there are many others, including food dyes, sugar substitutes like saccharin and aspartame, pesticides, and many of those things on labels that are unreadable chemical constituents. These exposures are modern analogs for the classical Chinese medicine concept of dampness and heat and wind belonging to the external pernicious influences (EPIs). See any Huang Di Neijing Su Wen for in-depth and classical explanations of these concepts.
In CRC these pathogens evolve into two manifestations: organ toxin (zang du) and intestinal wind (chang feng). Du refers to poison and to many other things, including toxic heat, pathogenic damp– heat, inverted fire, wind–heat, and latent pathogenic factors.84 The toxins that enter the digestion from contaminated foods and water are all a form of external toxin exposure. In the case of the promoting factors for CRC, toxins can also form endogenously through an improper diet that leads to excess bile acids, which foster the growth of anaerobic bacteria.85 Promoting factors are those things we do that create an environment that is conducive to the evolution and proliferation of cancers. Diet is one of the primary promoting factors, and the most common result is damp phlegm stasis.
Chang feng refers to the accumulation of wind–heat or the constant exposure to wind–heat in the intestines, where it forms toxins. The evolution of colon cancer usually takes about 8–10 years. This constant exposure is key to the injuries that accumulate over time in CRC. Wind–heat is primarily an external exposure from contaminated food but anaerobic bacteria may also be considered a form of wind–heat, and so the two are related. As well, the promoting factor for spleen deficiency is related to both of these manifestations, because spleen deficiency allows a greater insult to take place from external and internal pathogenic processes, partly through deficient Ying Qi, which in modern medicine equates to the IGg and IGm immune capacity of the mucosal lining of the gut, and partly through deficient function of the spleen’s charge of transportation and transformation. Spleen deficiency, also leads to blood dryness, then blood deficiency and then blood stasis. And blood stasis is a terrain on which heat and toxin evolve. The inflammation from these injuries has a direct relationship to the evolution of cancers and, in this case, to the evolution of CRC.
The spleen/pancreas is the middle and the mother of the body. It is the Earth. It expresses the twofold meaning of simultaneously receiving and giving. The functions of the middle Jiao and spleen are most easily injured by neglect. Neglect is something in which parents engage, and every human being must first learn proper parenting of themselves. If the spleen function is weak, the liver can overact in a transverse rebellion that becomes stronger and more symptomatic over time. A vicious circle is begun where the injured spleen fails to nourish the liver blood, which then causes restraint and a stronger transverse rebellion that weakens the spleen even more. These stresses can lead to spleen Yin deficiency, a precursor of spleen Yang deficiency, and a sign that body fluids are deficient. This can be amplified by liver blood and Yin deficiency. A transverse rebellion also contributes to spleen weakness and the loss of transforming and transporting functions, which result in dampness and then phlegm.86 Therefore, the dampness and phlegm come from two sources — spleen deficiency and spleen deficiency leading to a transverse rebellion from liver constraint. A stomach and gallbladder transverse rebellion can also evolve from this terrain. The result is acid reflux disorder, which is typically treated with antiacids. Antiacids lower the body’s ability to absorb calcium, and lowered calcium absorption can contribute to CRC.87
Spleen deficiency patterns manifest in signs and symptoms below the navel and in sinking spleen Qi. Damp accumulations are a form of sinking Qi. Polyps are a material form of dampness accumulation that is partly the result of dampness pouring down and partly a result of sinking spleen Qi. Intermittent stools are a manifestation of sinking spleen Qi and are a characteristic precursor of CRC.88 The diarrhea or loose stool aspect is due to Qi deficiency in the spleen and a failure to extract the right amount of water via the digestion. The constipation aspect is due to spleen Qi deficiency failing to support the Qi-transporting function of peristalsis. Diets high in sugar are an addictive expression of a poor diet. However, sugar is also a spleen tonic and is considered a Chinese herb. Many middle Jiao tonic herbs are high in polysaccharides and natural sugars. Eating a diet high in refined sugar is a poor attempt at righting a spleen imbalance and actually worsens it. It is part of a vicious circle.
In transverse rebellion the symptoms will manifest as combinations of excess and deficiency. Irregular and inadequate or excessive food intake, as in anorexia and bulimia, or in going too long between meals (more than 4–5 h during the day), sporadic eating and then binge eating because of low blood sugar — all of these are especially hard on the middle Jiao and the spleen. They are examples of how the liver–spleen relationship is injured. In these vicious circles it is often difficult to determine what is the chicken and what is the egg. The extremes cause serious injury to assimilative processes that may lead to food allergies, chronic constipation and/or loose stools, low digestive fire, Qi and blood deficiency, kidney Yang deficiency, and issues of water metabolism. All of these contribute to more and more extreme spleen deficiencies, damp accumulation, stasis, and then heat. These are all underlying concepts of Chinese medical theory that are foundational to cancers.89 A recipe for cancer is born over time.
Adenomatous polyps are a form of damp/phlegm stasis, a possible latent pathogenic factor, that act as a magnet for toxins and for wind– heat drawing these exposures deeper into the body.90,91. Therefore, the internal and external contributions to the pathogenesis of CRC are intertwined and complex. The inhibition of the immune and surveillance system of the mucosal lining of the gastrointestinal tract is also due to spleen deficiency and injury to both the Ying and Wei aspects of immunity, since the spleen has a direct relationship to both of these aspects of the immune system according to Chinese medicine. 92
Because of the spleen’s orb of function to transform food and fluids, spleen deficiency allows pathogenic accumulations like polyps, anaerobic bacteria, and increased bile acids from foods, and these in turn cause further spleen deficiency. The bowel’s ability to separate the pure from the impure is damaged and signs like intermittent diarrhea and constipation, mucus in the stool, hemorrhoids, and blood stasis occur. All of these problems either expose the intestinal wall to constant pathogens or scrape away the mucosal lining (in the case of diarrhea), lowering immunity and protection from these pathogens. The mucosal lining is lessened and rebuilt with every bowel movement and one or two stools per day is adequate in a proper diet that conserves the spleen Qi. Frequent diarrhea damages the mucosal lining and depletes the spleen function as it tries to repair its orb of action. This depletes the Ying Qi. Accumulations of dampness, phlegm, phlegm heat, and toxins injure the Qi, and enter the blood level and cause stasis, leading to malignancy.93
Besides the diet leading to these conditions, there are other risk factors for CRC. Lynch syndrome types I and II both have a markedly higher incidence of CRC.94 Familial polyposis, where multiple adenomatous polyps after the age of 10 years can literally carpet the colon wall, is a risk factor. A previous history of polyps in the colon demonstrates that an underlying environment has not been addressed and polyps can continue to form because of this lack of dietary and lifestyle change. People who suffer from inflammatory bowel disease (IBD), ulcerative colitis, or ileitis (Crohn’s disease) have a greatly increased risk of CRC.95 In ulcerative colitis the risk is 20 times the average.
Other risk factors for CRC include high consumption of charbroiled foods.96 The charbroiling of foods and especially animal fats changes normal fats/oils into carcinogens through exposure to high heat. These carcinogens are wind–heat toxins. Chronic constipation is also a risk factor, because the longer the transit time for the stools, the longer the exposure of the bowel wall to toxins of various kinds, depending on one’s diet. Asbestos is also a known cause of CRC and is probably a wind–heat pathogen.
The evolution to CRC usually takes about 10–15 years97 but can take even longer in these cases. Early symptoms of digestive imbalance require an in-depth intake and evaluation. Patients need to be taught how to parent their own body by eating a proper diet. Explaining what a proper diet is within the traditional framework of the individual patient is one of the most important interventions in which a practitioner can engage. Teaching patients how and where to buy food and how to cook are baseline actions for providers. All of the early symptoms of digestive imbalance are immensely important to pay attention to because some of them can evolve into conditions that place an individual at greater risk for CRC.
Spleen Patterns in Detail (98)
The spleen takes fluid from the kidney and adds nutrition. It then sends body fluid to the stomach along with directives about how to use it. We could say that these directives are in the form o enzymes. Spleen Yin deficiency is caused by insufficiency of body fluid. As the spleen becomes deficient, the route of body fluid that supplies nutrition shuts down. As the fluid decreases, the whole becomes insufficient and empty heat rises. The cause of this condition is overwork, insufficient sleep, and a poor diet. The whole body becomes fatigued; the patient may feel discomfort from low grade fever or a sense of malaise. This is especially true in spring or summer, when the natural environment is filled with Yang and the human body is open. The experience is one of feverishness and malaise. The empty heat rises to the surface and gets dispersed. In the fall and winter, the experience is the opposite and the patient with this pattern may easily feel chilled because they are deficient.
As this pattern deepens, cramping or pain in the muscles can result, because body fluids are low. Some forms of fibromyalgia are due to this condition. The spleen is unable to deliver body fluids to the muscles along with, one would think, calcium. Adults may appear lazy or inactive, there is little appetite, the stools are loose, urine is more frequent, and the mouth is dry. The patient will crave water in the summer, partly because they are not eating. Overeating or mild food poisoning can also produce these symptoms. In a typical American setting, it is probably the combination of overworking and worry to make ends meet, improper eating and eating of foods that are truly pseudofoods, plus food contamination, that leads to this condition. It may also be seen in some patients with chronic conditions related to cancer therapies.
This condition becomes more prominent in the stomach and large intestine. Heat can stagnate in these organs. When an EPI invades, in the first stage there is chill and fever. When it does not resolve and progresses, it invades the yangming channel, resulting in fever and dry throat and dryness in the eyes and nose. There may be diarrhea and vomiting. If antipyretics are given to lower the fever or laxatives are given to move the stools, the heat will be drastically reduced. However, even more body fluid will be lost, exacerbating the condition of spleen Yin deficiency.
In spleen deficiency the pulse is not well defined. It is easier to say what it is not. It is soft and amorphous without proper boundaries. Tonifying fire points like Sp 3, P 7, Sp 2, and P 8 can help to provide the spleen with Qi in order to lend definition to the pulse so as to enable a clear diagnosis.
Spleen Yin deficiency with heat in the bladder
Heat in the bladder is difficult to determine via the pulse. However, the abdomen over the bladder organ will be hot to palpation. The patient will also feel pressure pain in this area. The pattern is caused by febrile disease, like a bladder infection, or is due to incorrect treatment of a febrile disease.
When a patient is having fever, they may feel extreme thirst but cannot urinate. The heat is restrained in the back taiyin and goes into the fu organ — the urinary bladder. Yin Earth cannot control Yang water. Treatment concentrates on returning urinary function. Steamed green onions over the lower abdomen combined with acupuncture points will work. This pattern has been seen in prostate cancer patients who have been treated with brachytherapy and/or external beam radiation.
Stomach Yang deficiency with heat in the chest
A cold stomach is often caused by pharmaceutical drugs and by improper eating habits. This results in middle and lower burner cold. Heat stagnates in the upper Jiao, because the heat exchange mechanism at the diaphragm is not functioning. The symptoms include substernal tightness, borborygmus, unrelenting hiccups, belching, and irregular appetite. Appetite is regulated when there is circulation between the upper and lower burners. When the harmony is broken, the appetite becomes irregular. There is underlying spleen deficiency with loose stools and incomplete evacuation. At the same time, there are ulcers in the mouth or tongue, or canker in the corner of the mouth. There also may be sinusitis, because of upper burner lung heat and insomnia. This is a very common presentation of patients undergoing cancer treatment, especially with chemotherapy. The oral ulcers can be assumed to be present in much of the gastrointestinal tract lining. That lining is within the purview of the spleen.
Stomach Yang deficiency with water stagnation
“Swallowing phlegm disease” occurs in patients with spleen Yang deficiency. Water easily becomes stagnant in this pattern. Wrong treatment, constitution, and diet all contribute. The symptoms are vomiting, diarrhea, dysuria, headache, dizziness, palpitations, substernal pain, poor appetite, and cold extremities. There is no thirst. Very commonly there will be a prolapsed stomach and this is why the water is stagnating. The prolapse may be due to a hiatal hernia. It is the heat rising from stagnation that causes the headache. Treatment consists of Si 4, Sp 3, P 7, Sp 4, and Bl 39 (he-sea point of the San Jiao). For prolapse use St 36 and the extra point for prolapse medial to St 39 against the tibia.
Spleen Yang deficiency with severe Spleen Yin deficiency
Spleen Yin deficiency deteriorates into spleen Yang deficiency. As body fluids decrease, empty heat becomes static in the stomach. When deficient body fluids are severe, the stomach becomes completely chilled. Body fluids are interpreted as blood and, therefore, this condition is considered serious.
The causes are childbirth, abdominal surgery like a Whipple procedure, constant worry, and loss of a very close relative. Insomnia is the primary symptom. Blood deficiency insomnia has the characteristic of never actually falling asleep. There is a tendency to bleed from the nose, anus, uterus, and intestines. It is not due to platelet deficiency. There is no appetite. The stomach has stopped functioning.
Severe deficiency creates a small heat that leads to low-grade fever in the late afternoon or evening. There is no fever in the morning. This pattern is difficult to recover from. Strong treatment will cause deterioration. Often the pulse is big and floating. As Yin and Yang are tonified, the pulse will shrink and sink. This is an improvement. This pattern is not uncommon in later-stage cancers where many treatments have been given over time. Even though the chemotherapy is given by intravenous infusion, its impacts are still systemic and include damage to the middle Jiao. Over time, the middle Jiao damage becomes severe.
Spleen deficiency and liver excess
Pathogenic Qi goes through stages and can affect any organ with fever or heat. It begins with a weak spleen and therefore it tends to show in the liver or pericardium. The main symptom is fever that rises and falls. With pathogenic heat in the liver there will be hepatitis. Heat in the abdomen can manifest as constipation, lack of appetite, or a bitter taste in the mouth. When this condition is present, heat can easily enter the lung or kidney.
Pathogenic heat in the lung presents with wheezing cough and pneumonia. In the kidney the presentation is dysuria, edema, or nephritis. Kidney pathogenic heat shows with an excess pulse but the practitioner may have to rely on the symptoms for diagnosis. When a patient has a problem with the zang organs, it is often safe to guess that it is coming originally from the spleen. The root cause of the acute condition is in reality a chronic condition.
Spleen deficiency with liver excess and blood stasis
Blood stasis comes from chronic patterns. It is a common gynecological problem but it is also seen in HIV masses and tumors and other static blood conditions like Kaposi’s sarcoma. Hardness around the navel is indicative of blood stasis. Cupping the navel will give information about the level of blood stasis. Common moving points for this condition are Sp 3, P 7 and dispersing Lv 14 and Lv 8, Sp 10 and Sp 6. Use moxa on Bl 17. Bloodletting on jing-well points and vascular spiders is also helpful. Movement is one of the very best mechanisms for treating blood stasis.
Spleen deficiency with lung excess
Symptoms of pneumonia will have pathogenic heat that has entered the liver, creating a spleen deficiency and liver excess condition that enters the lung via the ko cycle. The chest is painful with pressure. There is a high fever and constipation.
Spleen deficiency with kidney yang deficiency
If the Yang Qi has collapsed, ming men fire weakens and the kidneys are weakened also. When there is spleen Yin and Yang deficiency, this is called kidney Yang deficiency. The symptoms are dribbling urine and diarrhea. The treatment is to tonify Sp 6, K 3, Sp 9, Bl 58, and BI 59. If the back shu are tonified, care must be given not to leak Qi or deplete the Yang Qi of the taiyang channel.
Irritable bowel syndrome; Inflammatory bowel disease, Ulcerative colitis; Crohn’s disease
Gastrointestinal diseases are divided into two categories: structural and functional. IBS and IBD are gut motility disorders that are functional in nature; no pathophysiological mechanism in conventional medicine has been identified for IBS.99 IBS has been known as nervous dyspepsia, spastic colon, irritable colitis, nervous colitis, or intestinal neurosis. Although it can occur at any age, its incidence tends to be concentrated in the 20–40-year age group. The incidence of CRC is far higher in patients who have an ongoing history of IBD, ulcerative colitis, and Crohn’s disease. Many people diagnosed with IBS recall suffering from similar symptoms during childhood and adolescence. Women are three times more likely to suffer from the chronic symptoms of IBS. However, since men do not seek medical advice as frequently as women, it may be underreported in men. Patients with IBS make approximately 2.5–3.5 million physician visits annually.
Mixing and propulsive contractions constitute the movement in the bowel.100 Normally, chyme stretches the intestinal wall, promoting a series of regularly spaced concentric contractions called segmentations. Chyme is the semiliquid acid mass that is the form in which food passes from the stomach through the small intestine. It is the result of the rotting and ripening function of the upper digestive tract. As each segment relaxes, a new one begins chopping the chyme into sections at about 8–12 turns per minute, thoroughly mixing food with intestinal secretions, depending on whether one is in the upper, middle, or lower digestive tract. The combined contraction of smooth and longitudinal muscle in the colon causes portions of the large intestine to bulge outward into balloon-like sacs called haustrations. Colonic slow-wave contractions are normally measured at a cycle of six per minute in the sigmoid and rectum. But, in IBS patients, this cycle occurs only three times per minute, regardless of whether the patient is experiencing symptoms. This is why IBS has been designated an intestinal motor function or motility alteration. IBS patients who are fasting experience no increase in contractile activity during the fasting phase. However, when they eat there are spikes in the myoelectric activity that coincide with episodes of cramping abdominal pain.
Colonic symptoms of IBS include: (101)
- Diarrhea — frequent, loose, and watery, mostly in the morning;
- Constipation — consisting of small pellet-like stools (goat turds), or bowel movements less than three times per week;
- Stool urgency;
- A feeling of incomplete evacuation;
- Intestinal spasms;
- Acute abdominal pain — usually cramping in the left lower quadrant; may be worsened by eating and temporarily relieved by bowel movement or passing gas;
- Bloating and flatulence — usually mildest in the morning but worsening as the day progresses; bloating may be severe enough to force the patient to loosen their clothing;
- Thick, pasty stools that are difficult to eliminate and have a foul odor;
- Hypersecretion of colonic mucus.
Noncolonic symptoms of IBS include:
- Acid regurgitation;
- Back and thigh pain;
- Urinary frequency and urgency;
- Nausea and loss of appetite;
- A general feeling of weakness;
- Varying degrees of anxiety or depression;
- Dyspareunia — painful or difficult sexual intercourse for a woman;
The classical symptom triad consists of abdominal pain, distension, and altered bowel movements. However, almost 50% of IBS patients feel that the noncolonic symptoms are more intrusive.
The triggers may include antibiotic or other drug use, infection, abdominal surgery, food intolerances, stressful or emotional situations, and sleep deprivation. Some researchers characterize IBS as a purely psychological disorder. And it is true that IBS patients have a significantly higher prevalence of major depression and generalized anxiety, panic disorder, as well as childhood rape or molestation. It is difficult to determine if these disorders are ones of cause, effect, or coincidence. However, these symptoms resemble posttraumatic stress disorder (PTSD).
There are some conditions that may mimic IBS. These include:
- Disturbed bacterial microflora as a result of antibiotic use;
- Diverticular disease;
- Infectious diarrhea like giardiasis;
- Inflammatory bowel disease;
- Intestinal candidiasis;
- Lactose intolerance;
- Laxative abuse;
- Malabsorption diseases like celiac disease;
- Mechanical diseases like fecal impaction;
- Metabolic disorders like diabetes, hyperthyroidism, or adrenal insufficiency;
- Response to dietary factors that interfere with digestion, like excessive coffee, carbonated drinks, or simple sugars in excess. IBS is often classified according to those symptoms that are most frequent:102
- Constipation with abdominal pain;
- Functional diarrhea;
- Foregut dysmotility — bloating and discomfort after eating;
- Extrabowel manifestations like lethargy, migraine, or urinary symptoms.
The key to diagnosis, if not already done by another provider, is effective history-taking. This is often a diagnosis of exclusion and is based upon characteristic bowel patterns, time and character of pain, physical exam and palpation including of the hara,103 and routine diagnostic procedures that rule out other causes (may need to be done by a different provider). The typical laboratory tests that are done are an ESR to rule out inflammatory problems, a CBC, stool examinations for parasites, fecal occult blood (cancer), WBCs which can suggest infection, food allergy testing (which can be done through an elimination diet rather than RAST or a blood test), a barium enema, and sigmoidoscopy. It is important to remember that when ruling out colon cancer, only a colonoscopy is completely definitive because only colonoscopy looks at the entire colon.104
Elimination of aggravating factors that then reduce symptoms may be one way of diagnosing IBS when all other factors and risks have been ruled out.
The things that aggravate the condition include:
- Gluten foods — wheat, oats, barley, and rye;
- Foods one is allergic to — most common are wheat, corn, andmilk;
- Check the stools for candidiasis and treat with lactobacillus except in Crohn’s disease.
The elimination of aggravating factors is sometimes combined with treatment to heal the GI mucosa in holistic medicine. The following have been found to be useful in this healing 105:
- Some liquid food products of high quality, e.g. Metagenics;
- Glutamine at 500 mg–1000 mg;
- Cabbage juice (avoid brassicas in Crohn’s);
- Robert’s formula;
- Quercitin — a bioflavonoid;
- Some antispasmodics, like peppermint oil in enteric caps 200 mg bid;
- Chamomile tea;
- Increase fiber;
- Rice bran;
- Psyllium seed powder — 1 tbsp. daily in 8 oz. water;
- Fenugreek seed crushed in tea;
- Decrease stress through counseling, biofeedback, yoga, or meditation;
The diagnosis according to pain qualities: (106)
Nature of the pain
- Qi stasis — distension and bloating;
- Blood stasis — stabbing, fixed pain;
- Empty conditions — stuffiness.
Reaction to pressure and palpation
- Aggravated by pressure — excess and full conditions;
- Better with pressure — deficiency conditions.
- Hard abdomen — excess;
- Soft abdomen — deficient.
Reaction to activity/rest
- Better with moderate exercise — stasis;
- Better with rest — deficiency.
Reaction to bowel movement
- Better with passing of stools — a “substantive pain,” — due to blood
- No change with passing of stools — a “nonsubstantive pain,” due to
dampness, Qi stasis, cold.
Following are varying and overlapping diagnostic patterns for what are commonly called IBS, colitis, or Crohn’s disease in Western terminology. IBD and Crohn’s disease are considered high-risk factors for CRC.
Irritable Bowel Syndrome Treatment (107)
(1) Transverse rebellion with spleen deficiency and an overcontrolling liver
- Recurrent borborygmus;
- Abdominal pain;
- Diarrhea with pain that is better after passing stools;
- Tongue — a thin white coating;
- Pulse — wiry moderate or wiry thin.
The pain is caused by a transverse rebellion of liver Qi ; this depletes the spleen and impacts the motility of the peristalsis of the intestines. The diarrhea is caused by a collapse of spleen Qi leading to a loss of the spleen’s ability to transport nutrients upward, with a concurrent descending turbidity.
Dampness is a component of the weak spleen function but the tongue does not demonstrate this because all of the dampness is going down and does not affect the tongue coating. If the diarrhea were a result of damp excess and turbidity accumulating in the intestines, then the tongue would have a thick white coating. This is one way to differentiate this type of diarrhea and helps in the understanding of treatment options.
In this presentation the treatment principles are to spread the liver Qi and to tonify the spleen. The main formula is:
Tong Xiao Yao Tang (108)
(2) Dry intestines due to injury from a warm febrile disease
- Constipation that is dry, with stools that are difficult to pass;
- Thirst and dry mouth;
- Little appetite;
- Abdominal pain not better with passing of stools;
- Tongue — dry and red;
- Pulse — thin and rapid or weak and forceless.
When there is a history of a warm febrile disease or chronic symptoms over a long time in a patient with constitutional Yin deficiency, heat will clump in the yangming. This depletes fluids, especially in the large intestine, where the final extraction of water occurs in the body. This leads to dry hard stools that are difficult to pass.
The treatment principles are to generate fluids, moisten dryness, and unblock the bowels.
(3) Middle Jiao Yang deficiency
- Diarrhea with watery stools;
- May have nausea or queasiness;
- No thirst;
- Little appetite;
- Abdominal pain;
- Tongue — pale;
- Pulse — submerged and thin.
If the spleen is deficient, the clear Yang cannot rise, and this causes diarrhea and watery stools. If the stomach loses its ability to make the turbid Yin descend then the stomach Qi will flush upward and nausea will result. Low appetite indicates spleen deficiency.
Cold in the abdomen causes contraction and, therefore, pain. Cold is also an indicator of no thirst and of the tongue color and submerged pulse.
The treatment principles are to warm the middle Jiao and to strengthen the function of the spleen–stomach axis.
The main formula for this presentation is:
Wen Pi Tang (109)
(4) Spleen Qi deficiency
- Pale complexion;
- Low and soft voice;
- Low appetite;
- Loose stools;
- Possible abdominal pain around the umbilicus;
- Weak limbs;
- Tongue — pale;
- Pulse — thin and weak or moderate.
Improper eating habits, overwork, obsessive thinking, and worry all damage the spleen/pancreas. The transformation of food into blood and Qi is impaired. This makes the voice low and the complexion pale, and reduces the appetite and the ability to digest foods because of loss of transport through the stomach (formation of chyme). This results in unformed stools. And since the spleen governs the muscle tissue and some forms of connective tissue, weakness in the extremities is a common complaint. This is garden variety spleen/pancreas deficiency that can take on so many different manifestations.
The treatment principles are to tonify the zheng Qi and especially the spleen Qi.
The main formula could be:
Xiang Sha Liu Jun Zi Tang110
As is true with all of these presentations, there are many herbal formula possibilities.
(5) Liver invading the spleen or transverse rebellion
- Alternating constipation and diarrhea or loose stools;
- Abdominal and epigastric distension;
- Poor appetite;
- All worse with tiredness or depression;
- All worse with anger or worry;
- Tongue — pale, possibly dark, greasy white coating;
- Pulse — wiry and slippery but forceless
This is a very common presentation, especially for women (who are more likely to be diagnosed with any of these conditions). A transverse rebellion occurs when the spleen is weak or the liver Qi is stagnant. There is not necessarily a way to say which came first. If the spleen fails to nourish the blood, then the liver blood is deficient and fails to nourish the liver. This can lead to liver Qi stasis and constraint. Constraint itself can cause the liver Qi to rebel transversely and injure the spleen function, causing it to fail to transform and transport. Thus, a vicious circle evolves that gets worse and deeper wearing tracks of injury in the body, causing widespread harm.
Depression, anger, frustration, lack of self-esteem, and lack or loss of one’s vision for life can cause liver Qi damage. Constant worry and obsessive thinking over what could have been or what could be or might happen cause spleen/pancreas damage. Because the liver/gallbladder and stomach/spleen are part of the up-and-down, horizontal, and circular flows of the middle Jiao, injury to any of these for whatever reason can upset the apple cart, so to speak. It may be one reason why IBS has been considered to be a psychiatric disorder. And certainly various stress reduction, biofeedback, and meditation techniques have helped in recovery from IBS. IBS is very much emblematic of the mind–body connection.
The treatment principles for this pattern are to tonify and uplift the spleen, smooth the liver Qi and nourish the liver blood.
The common formulas for this pattern:
Xiao Yao San and Tong Xie Yao Fang (111)
The symptoms and patterns can be similar to those for item No.1 under “Irritable Bowel Syndrome Treatment.” However, they also include:
- Weight loss;
- Rectal bleeding;
- Loss of bodily fluids and nutrients;
- Skin lesions;
- Growth failure in children.
These signs and symptoms characterize an inflammatory disease that is much more serious than IBS. It is the inflammation that makes colitis or IBD a high-risk factor for CRC.
Possible diagnostic patterns:
(1) Externally contracted wind-cold with concurrent internal injury due to stagnation
- Nonspecific acute colitis;
- Fever and chills;
- A “men” sensation, i.e. chest stifling;
- Epigastric and abdominal pain;
- Nausea and perhaps vomiting;
- Loss of taste sensation;
- Tongue — a white and greasy coating;
- Pulse — moderate or soggy.
An EPI that is wind–cold constricts the Wei Qi, producing chills, and battles with the normal Qi, producing fever. The taiyang channels that traverse the head at the Yang point will be affected by cold and cause headache. The internal stagnation obstructs the Qi mechanism in the middle Jiao, leading to a “men” sensation. It also disrupts the normal ascending and descending functions of the middle jiao, causing abdominal pain, nausea, vomiting, borborygmus, and diarrhea. Internal stagnation of damp causes loss of taste and also the presenting tongue and pulse.
Although this is presented here as an acute condition, wind and cold pathogens can be extended to include some allergic foods and some chemical exposures to which many people are exposed on a daily basis. Remember that the interior of the gastrointestinal tract is an inside/outside phenomenon and the same types of pathogens that attack the lung and taiyang can attack the intestines. The route of entry is somewhat different but the impacts are similar in manifestation — cramping pain, mucus production, diarrhea (almost like the equivalent of sneezing), and so on. Because many of these impacts are new and without an historical basis from which to derive a pattern category, it is up to us to determine the characteristics of the impact and then from them find the pattern diagnosis for determining treatment options.
The treatment principles in this presentation are to release the exterior, transform dampness, regulate the Qi, and harmonize the middle Jiao. Does this sound familiar?
(2) Spleen and kidney yang deficiency
- Wu gen xie; cock’s crow diarrhea;
- No appetite;
- Undigested food in the stools;
- A weak and aching low back that is chronic;
- Cannot eat many foods, because they cause upsets, or cannot be fully digested;
- Abdominal pain that is chronic but worse with some foods;
- Tongue — pale, may show tooth marks, may have little coating;
- Pulse — submerged and slow.
Diarrhea that occurs at 5 a.m. every day happens because when the Yin is at its peak and the Yang is just starting to rise, fluids prevail. If the kidney Yang is weak, the Yang will not properly rise and the Yin will suddenly descend, causing diarrhea especially at that crucial moment of Yin–Yang exchange. Spleen and kidney Yang deficiency manifest as a lack of interest in food; the digestive fire is low but hopefully not out. An inability to “cook” internally what is eaten results in undigested food in the stools. There is no fire on which to cook the food. Pain results from cold contracting the abdomen or musculature of the bowel wall, causing spasm. The food allergies are due to the spleen’s inability to transform and transport. The fatigue and lethargy are typical signs of Yang deficiency but are also possibly due to malnutrition and resulting anemia. The tongue and pulse are both from spleen and kidney Yang deficiency. The tongue is pale from Qi and blood deficiency, because the spleen is not transforming food to Qi and blood. Cold may contribute to that. The tooth marks are due to spleen deficiency failing to transform fluids. Kidney Yang deficiency may contribute to that although upper body edema is primarily a sign of spleen deficiency. The little tongue coating indicates that the spleen has not the Qi to give a normal white coating to the tongue. The submerged pulse indicates Yang deficiency and cold, and the slowness indicates cold.
The treatment principles are to warm the middle Jiao and to benefit the Yang of the kidneys.
A typical formula for this presentation is Zhen Wu Tang (112) or even Si Shen Wan (113)
The above pattern can sometimes be seen in patients who have suffered chronic dysenteric disorders that have never been resolved. We rarely see this in the West but it can be seen in Africa and other countries where parasitic infestations, especially in children, are more common. The dysenteric disorder was originally a damp–heat pattern but over time the spleen and stomach, and possibly even the kidney Yang, are injured and the condition transforms into one of cold from deficiency and loss of fluids. In the West, some of these more severe presentations can be seen in HIV/AIDS patients and sometimes as a result of multiple drug therapies over years of treatment or as a result of an undetected parasitic infection — most commonly giardiasis or cryptosporidiosis.
The treatment principles in these cases can be to warm the middle Jiao, return the Yang to the Source, and bind up the bowels, which means to astringe intestinal fluids, while discharging the pathogen. In stronger patients, where parasites are present, a two-stage process is undertaken that first expels the parasites and then rehabilitates any function that was injured by their presence and by the process of expulsion. In weaker patients, the use of cathartics is contraindicated and a slower approach that concurrently drains and tonifies is employed.
The symptoms and patterns are similar to those for colitis and include the following specifically for Crohn’s:
- Reduced appetite;
- Difficult digestion;
- Bloating and focal distention of the epigastrum and lower abdomen;
- Loose and watery diarrhea;
- Tongue — yellow greasy coating;
- Pulse — frail.
The digestive symptoms in this picture come from stomach/spleen deficiency that leads to food stagnation. Even though there are excess symptoms in this presentation, the main treatment is to tonify the spleen so as to harmonize the stomach/spleen and resolve food stagnation and diarrhea. Although this sounds more simple than any of the other pattern strategies presented here, treating Crohn’s disease is a long term process. There are degrees of spleen deficiency, and the degree of spleen deficiency in Crohn’s is severe. Some patients end up having portions or all of their colons surgically resected.
All the Chinese medicine pattern diagnoses may be relevant to any of the Western diagnoses presented here. The main points in diagnosis are to identify the abnormal flows of Qi, to rule in or out parasitic infestations, to understand the nature of the patient’s diet and eating habits including conditions under which they eat or do not eat, surrounding symptoms like heat or Qi flushing up, turbidity sinking downwards and to assess the general strength of the upper and middle digestive tract.
General consideration in treatment
If we look at the traditional functions of the spleen/pancreas in Chinese medicine, we see elements of many conventional medicine body systems. The anatomical spleen is a part of the immune and lymphatic system; one suggestion is that — since the Chinese medicine concept of the spleen includes the production of the Ying Qi — the mucosal lining of the entire GI tract, the IgE and IgM aspects of intestinal immunity, and possibly many aspects of the lymphatic system of the abdomen along the GI tract are part of the spleen terrain. This area contains more lymph than any other part of the body. The mesenterium and greater and lesser omentum are also aspects of immune organs that speak to the spleen’s relationship with the Ying, the San Jiao, and water metabolism.114
The spleen also plays a major part in food metabolism. The rotting and ripening function of the stomach, gastric enzymes and acids, pancreatic enzymes and sugar metabolism, and the ultimate formation of chyme can be attributed to the spleen/stomach/pancreas. Fat metabolism and, therefore, the gallbladder may be considered to be a part a part of this major body axis. And water distribution and absorption, much of which takes place in the upper small intestine (jejunum), is considered classically to be a part of spleen function.117B When looked at from this anatomical perspective, it becomes obvious why the spleen is considered the center of the body. It has a very large charge in overall body health. Metabolic disorders fall into this realm. The Chinese historical and metaphorical concepts regarding the middle Jiao and the spleen/pancreas axis are emblematic of the land, of farming, irrigation, and food storage. In other words, the microcosm of the body is an expression of the macrocosm of the Earth/Earth and its ecosystems. These concepts are depicted in the Taoist map of the human microcosm and the universal macrocosm. How healthy we are inside is indicative of how healthy our world is outside and vice versa.
There are many dietary and food recommendations that can be made regarding the middle Jiao and overall health. One main consideration is that the establishment of regular bowel habits is central to health. In fact, traditionally Chinese medicine has said that there are ultimately two necessary foundations for good health — regular stools and good sleep. Part of establishing regular bowel habits is to get adequate fiber, especially vegetable fiber, and drink at least half your body weight translated into ounces of water daily. Many of the fluids we drink are diuretic and a large percentage of people are chronically mildly dehydrated. This, of course, contributes to irregular stools and also to poor sleep from Yin deficiency, among other things.
Another aspect of recovering from IBS, IBD, colitis, or Crohn’s disease is to steam vegetables in order to break or soften the cellulose wall of vegetable cells. This enables chewing to do much of the breakdown of the nutrients within the cells before absorption.
Generally, humans are unable to chew enough and break down plant materials in an efficient way when eating only raw foods. Digestive fire is used to warm the raw food to body temperature, then more Qi is used to break down the cellulose wall of the food, and finally the actual assimilation and absorption can begin utilizing more Qi. Two additional steps are added to a raw foods diet. In summer raw foods are more easily digested. However, for people suffering from the above conditions with injury to the middle Jiao and spleen function, it is best to lightly steam vegetables before eating them. The Chinese also add ginger slices to tonify and warm the spleen and help it break down vegetables.
Root vegetables are high in polysaccharides and are easily digested while providing good food quality and nutrients. Squashes, yams, carrots, turnips, and rutabagas are all excellent foods for spleen deficiency. These foods are yellow or orange in color; they contain natural and complex sugars that are not contraindicated and do not break down in the same way as refined cane or corn sugars. Elimination of refined sugars is essential to CRC prevention and to re-establishment of a healthy GI tract. Refined sugars tend to paralyze the motility of the duodenum and jejunum and they contribute to the growth in the small intestine of nonbeneficial bacteria.115 These are the same bacteria that produce enzymes that are carcinogenic. Refined sugars “swamp” the spleen and all of its manifestations. Complex carbohydrates help to maintain a consistent blood sugar level over time and, therefore, help to curb sugar cravings. Again, sugar cravings are a sign of spleen deficiency from a poor diet. The habit of sugar includes injury to the spleen, just as the habit of nicotine includes injury to the lung, or the habit of alcohol includes injury to the liver.
Diets that are simple do not stress the stomach–spleen axis, and patients with IBS or other intestinal chronic conditions do worse with a complex diet where many foods are eaten at one sitting. Avoiding spicy foods with these conditions eliminates the irritation caused by them. If a patient complains that they cannot eat these food items without GI tract pain, then they should not. The modern use of antacids like Tagamet and Prilosec is not contributing to health. The need for these agents is due to eating foods that cause either hyperacidity or hypoacidity. They are symptomatic treatment and do not address the cause. The treatment goal in digestive functional disorders is to rebuild the gastrointestinal function through giving the digestion a rest and through food choices.
The use of Tums or other antacids in order to get one’s daily calcium dose is a mistake, even though many doctors recommend it. Calcium is absorbed best in an acidic environment. Tums reduces stomach acid, and therefore absorption of calcium is poor. Reducing stomach acid also leads to hypoacidity and poorer digestion of proteins. Meeting calcium requirements by using supplements that are often synergistically combined, like calcium and magnesium and vitamin D is a much more functional approach. Many people who use antacids are actually low in stomach acid and either have caused this problem, are treating a misdiagnosed problem improperly, or are worsening their problem by lowering stomach acid through the use of antacids. Calcium is a major contributor to colon health, among other things, and good absorption requires digestive fire including adequate stomach acids.
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- Ibid ., p. 147.
- Ibid ., p. 197.
- Ibid ., p. 359.
- Op. cit ., No. 103, Chap. 8.
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We are grateful to Tai Lahans for permission to reprint this excerpt of her book “Geology of the Modern Cancer Epidemic Through the Lens of Chinese Medicine”. Tai holds a bachelor degree from Cornell University, a MED from San Francisco State University, a PhD from University of California at Berkeley, and a PhD from China Academy of Chinese Medical Sciences, Beijing. She has taught extensively at several colleges of Chinese medicine, sits on many boards that are involved in advocacy for cancer patients, and is also author of “Integrating Conventional and Chinese Medicine in Cancer Care”.