I still remember many years ago, the loud "Yuck" from my wife at the time when we were together watching the Chinese movie "Last Emperor." A palace physician holds a container close to his face, examining and sniffing the waste freshly passed out by the little boy emperor, then the physician announces that emperor is in a good health. In a civilized culture, the digestive system, particularly the colon, generally do not get respect. In the U.S., people are somewhat more comfortable in talking about sex rather than the bowel movement or the fecal matter. A euphemism of "number two" is resorted to avoid the words and their nasty suggestion. To this day, even though the media has provided a good amount of related information, the loud "Yuck" is still echoing in the social customs, not much changes have been seen.
Nevertheless, the characteristic of patients' fecal matter has become no less than a precious diagnostic tool in my office. By obtaining detailed information from patients on their waste and frequency of bowel movement, we can have a general idea about patients' health issues and the body type of "cold, heat, deficiencies and excess," which provides the first step to a correct diagnosis.
Coloration
It is important to look at the coloration of the fecal matter. Bacteria in the intestines break down the Bilirubin in the bile into pigments which are responsible for the fecal matter coloration.
Brown is the normal color of poop that should not be alerted. The color is the result of normal process in which the waste is mixed with the digestive juices and the pigments. Light, clay colored indicates the biliary deficiencies, or gallbladder duct blockages. Dark black indicates the upper intestinal pathology. The fecal matter contains the dried blood. Dark shows a large portion of protein in the diet. Normal brown mixed with strokes of pink color is possibly a sign of bleeding in the lower part of the colon, such as bleeding caused by the hemorrhoids. Dark yellow indicates ingested food contains a good amount of vegetables or fruits.
Odor
The odor of feces is bacterial action on the ingredients of which indoles and hydrogen sulfide give the characteristic odor of feces. A foul odor generally serves as a sign of a stagnant bowel, but not necessarily an indication of the pathology. The gas odor is largely related with the food ingested and it varies individually.
By implementing the fecal matter diagnostic tool, not only can an acupuncturist determine the patients' health issues that can be treated with acupuncture and herbs but also, and more importantly, when serious internal disease is suspected, patients can be referred to their primary doctor with no delay.
Together with the gall bladder, stomach, small intestine, three burners, and bladder, the large intestine is an important part of the "six fu visera" which has the function of receiving, digesting, transporting and excreting the food and drink that expects no obstruction or storing waste.
The large intestine is also located in the hollow viscera of the three burner (San Jiao). In the analogue, the biological features of the three burners are depicted respectively as follows:
The upper burner is an organ of fogging.In the functional chain of metabolism, the food/drink digestion, assimilation, nutrition absorption and waste excretion, the upper burner has the role of transporting and distributing the nutritional essence to all the parts of the body. It is like a nutritional fog created, hovering over and nurturing the internal body. The two vitally important organs, lungs and the heart are located in the upper burner. According to the TCM theory, lungs dominate the qi and water passage, and the heart has the domination of blood and vessels.
Middle burner is an organ of soaking. By mechanical and chemical digestion, the ingested foods are broken down into the molecule level so that the nutrition contained can be absorbed. As preparation for the absorption, the process of food soaking, softening and fermenting is necessary.
Lower burner is an organ of draining and must keep its passages unobstructed. The large intestine is in the cavity of lower burner that has two major functions. One is passing through and draining the water, the other is the waste formation and excretion. Like the functions of toilet and sewage, the lower burner cannot afford the blockage. The large intestine must keep its detoxification channel cleared off, or some pathology will emerge.
Qi of zang-fu viscera. The qi of zang-fu viscera is the vital substance that fills all the spaces in the internal body cavities. It controls, coordinates all the operations of the internal organs. Outwardly, it is the manifestation of the individual life force.
I discovered that TCM literatures about the large intestine bear remarkable similarities to the understandings of the modern medical science. By adding the contemporary knowledge here and there, the seamless merge of the Eastern and Western medical theory on the pertinent part can be reached. I have found no difficulties in explaining TCM concept to my patients, and no conflicts really exist.
Acupuncturists are more routinely implementing the basic four diagnostic techniques in their practice, (inspection, auscultation and olfaction, inquiry, pulse-taking and palpation). Meanwhile, in the category of "inspection of excreta," the information of the patients' waste is generally not collected or is selectively overlooked. Due to the availability of the equipment and protocol, few of the TCM professionals are working on patients' fecal matter, through which, as the TCM theory teaches, valuable data can be obtained. Combined with the tongue, pulse checking, the overall picture of the patient health would display itself in a better clarities.
From the angle of the holistic view, everything in the body is interconnected and any changes happen to an individual organ would affect in one way or another, the other part of the body. TCM holds that the normal function of the large intestine relies on the kidneys, of their warming up body effects; the lungs' dominating and regulating qi and water; alongside with the performance of spleen-stomach in the digesting and assimilating processes. Normal bowel movement is the reflection of a good orchestration of the individual organ functions. Subsequently, the colon problems should not be handled separately or independently, but to be viewed as a manifestation of imbalance of yin and yang; the loss of the equilibrium in the whole body system, and further, the indication of the compromised functions of the lungs and kidneys.
When it comes to the formulation of the treatment plan, let acupuncturists not forget that TCM has an abundant resource of herbs, meridians and points and means of treatment to choose from. The school of "The treaties of spleen and stomach" advocates that all the diseases start with the issues of digestive system. This theory has tremendously influenced the TCM history. According to the TCM, the process of urination and bowel movement are in the control of kidneys, therefore, the treatment plan should always has place for strengthening and tonifying the kidney performances. Theoretically, the improvement of the lungs' function will help a number of colon issues as well, such as issues aroused from atonic bowel, since the lungs and colon are internally and pathologically connected, serving as the front and back end.
Put Into Practice
The majority of patients come to my office for digestive system issues and colon issues. New patient will be given an array that displays a list of pictures of poop shape and coloration, together with a word description sheet for patient to identify the composition, amount, odor of fecal matter and bowel movement time, etc. The conversation that follows would complete the inspection and inquiry process. Then the pulse checking and palpitation on the abdominal area would help form up the diagnosis, and formulate the treatment plan.
The basic approach in my practice focuses on the principles of "differentiation of yin and yang comes first" and "treatment aiming at its parthenogenesis." If a patient has acute constipation or some indigestion issues, an effective relief is necessary. After that a more holistic treatment perspective would be in place addressing the root cause of issues. This approach is in the philosophy of "symptomatic treatment in acute condition, radical treatment in chronic conditions."
In this polluted living environment, and as people live much longer, the gastrointestinal diseases are more pronounced than ever. Based on research findings and my four years of experience treating digestive and colon issues, the conventional medical means has demonstrated its limitation. It is hard for people suffering from the digestive system problems to add more chemical substance or synthetic medicine, and the antibiotic is one of the known culprits that causes the imbalance of gut flora. While diet and lifestyle changes help relieve the tensions but generally these changes are not addressing the underlying cause of the problem. Patients definitely need alternative options whereas, acupuncturists can play important roles to alleviate the imminent needs or even provide the viable solution. In my opinion, it starts from us as the experts in TCM disciplines in the alternative medicine field, to take advantage of the fecal matter diagnostic tool and do efforts to educate patients to be more open in dealing with their digestive and colon health issues.
As modern medical standardization continues, the field of traditional Chinese medicine has the advantage of comprehensive personalization. For rare or complex cases, deeper consideration of constitution is invaluable. Proper constitutional assessment, especially with first-time clients, can guide desirable and predictable outcomes. This leads to a higher rate of return, and greater trust between you and your patient.
Though the creation of a financially sustainable, health-promoting model feels far away today, we are casting a vision for a full return on health, believing that this compels us to keep one foot firmly rooted in caring for the sick and the other foot firmly founded in maintaining health. Shifting from a fee-for-service model to value-based care using a phased approach is paramount.
Laser therapy has emerged as a powerful tool in the realm of traditional Chinese medicine (TCM). This new modality fits beautifully into the toolbox of the modern acupuncturist, as it can be used as a hybrid form of stimulation to acupuncture points, meridians, organs, nerves, and symptomatic areas in a new way that blends both moxa and energetic needle-like responses.
