Guest guest Posted December 22, 2003 Report Share Posted December 22, 2003 > > The Maclean/Lyttleton text describes diarrhea due to LV/SP disharmony > > as diarrhea that alternates with constipation. > While gan pi bu he MAY cause diarrhea alternating with constipation, it may also cause simple diarrhea. There is aboslutely no question about this in the Chinese medical literature, and there is a huge body of Chinese literature on IBS. In fact, the Chinese literature on IBS is the most homogeneous I have seen on any single disease in terms of disease mechanisms and pattern discrimination. Bob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 23, 2003 Report Share Posted December 23, 2003 And according to Dr. Yang, the issue of diarrhea and constipation appearing during one " sitting " is possible as is the issue of constipation and diarrhea appearing on adjacent days. -al. On Dec 22, 2003, at 8:11 AM, Bob Flaws wrote: > > >>> The Maclean/Lyttleton text describes diarrhea due to LV/SP disharmony >>> as diarrhea that alternates with constipation. >> > While gan pi bu he MAY cause diarrhea alternating with constipation, > it may also cause simple diarrhea. There is aboslutely no > question about this in the Chinese medical literature, and there is a > huge body of Chinese literature on IBS. In fact, the Chinese > literature on IBS is the most homogeneous I have seen on any single > disease in terms of disease mechanisms and pattern > discrimination. > > Bob > > > Chinese Herbal Medicine offers various professional services, > including board approved continuing education classes, an annual > conference and a free discussion forum in Chinese Herbal Medicine. > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2003 Report Share Posted December 29, 2003 , Al Stone <alstone@b...> wrote: > And according to Dr. Yang, the issue of diarrhea and constipation > appearing during one " sitting " is possible as is the issue of > constipation and diarrhea appearing on adjacent days. > > -al. First sorry for the delay, playing major catch-up… I am unsure how this works; I would definitely like to hear more. My understanding is that both diarrhea and constipation refer to transit time (or time in-between bowel movements) and do not refer to consistency (dryness or looseness) So I find it difficult how these occur in one sitting? The way I have made sense of the alternating concept is this: (And this may have been said, I can't remember). When the liver is just constrained there is constipation, when it attacks the spleen it is loose. If the spleen is inherently weak then one will see loose all the time, and even if the liver is involved, strengthening the spleen should be considered more important. IF the spleen is just occasionally attacked from an overactive liver and the alternating occurs, the spleen is probably not as weak, and one can course the liver and just protect the spleen (Like xiao yao san) – and yes I don't really see this Rx tonifying sp qi. It makes sense that it protects (more). But I think this is semantics… It strengthens it, just how much and why… But theses of course have to be taken into consideration with other s/s, and yes sp xu can cause constipation, but I think this is a different issue. Thoughts? Hope everyone is having a happy holiday… - Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2003 Report Share Posted December 29, 2003 On Dec 29, 2003, at 6:52 AM, wrote: > , Al Stone <alstone@b...> > wrote: >> And according to Dr. Yang, the issue of diarrhea and constipation >> appearing during one " sitting " is possible as is the issue of >> constipation and diarrhea appearing on adjacent days. >> >> -al. > > First sorry for the delay, playing major catch-up… > > I am unsure how this works; I would definitely like to hear more. > My understanding is that both diarrhea and constipation refer to > transit time (or time in-between bowel movements) and do not refer > to consistency (dryness or looseness) So I find it difficult how > these occur in one sitting? Well, there you go. I'm talking about consistency mostly. For instance, having three well-formed bowel movements in a day would lean me toward Qi stagnation that prevents everything from evacuating in one sitting rather than " loose " stools diarrhea. > The way I have made sense of the alternating concept is this: (And > this may have been said, I can't remember). > > When the liver is just constrained there is constipation, when it > attacks the spleen it is loose. If the spleen is inherently weak > then one will see loose all the time, and even if the liver is > involved, strengthening the spleen should be considered more > important. IF the spleen is just occasionally attacked from an > overactive liver and the alternating occurs, the spleen is probably > not as weak, and one can course the liver and just protect the > spleen (Like xiao yao san) – and yes I don't really see this Rx > tonifying sp qi. It makes sense that it protects (more). But I > think this is semantics… It strengthens it, just how much and why… This seems okay to me, what you just wrote. Still, I do see Xiao Yao as having some tonification properties for the Spleen, but this is its secondary effect. If the loose stools brought on by Liver attacking Spleen is intermittent, I would lean toward the Xiao Yao. This would made sense for a PMS type diarrhea which only arises for a day or three per month. However, I don't often see the intermittent diarrhea type patients, but rather those who are an hour late to an appointment because they couldn't get off the toilet. Its still Liver attacking Spleen, but with a much more severe presentation of diarrhea. In this case I like the Tong Xie Yao Feng. I make mine with Chao Bai Shao and Chao Bai Zhu. I like the warm toasty energy of these two herbs to strengthen, warm, and dry the Spleen. I'd also like to add a little trick that Dr. Yang teaches in regards to the pulse and differentiating when the Spleen is deficient and when it is being attacked by the Liver. When the right Guan pulse is slippery and the left Guan pulse is wiry, this is the natural state of things and there is no Liver/Spleen disharmony. The right Guan pulse is associated with the Spleen and its natural pulse is on the slippery side. The left Guan pulse is associated with the Liver and its natural pulse is wiry. When the left Guan is slippery and the right Guan is wiry, these are reversed and indicate that Liver/Spleen disharmony which we've been calling Liver attacking Spleen, but I suppose it could also indicate Spleen dampness causing stagnation which would be called Earth insulting Wood. It is still an Spleen/Liver disharmony. > But theses of course have to be taken into consideration with other > s/s, and yes sp xu can cause constipation, but I think this is a > different issue. > Thoughts? Yeah. Spleen Qi xu constipation isn't stress induced, but due to a lack of motive force in the poop shoot. Still, given time, I have to assume that Liver attacking Spleen plus time could lead to that kind of constipation. -- Pain is inevitable, suffering is optional. -Adlai Stevenson Quote Link to comment Share on other sites More sharing options...
Guest guest Posted December 29, 2003 Report Share Posted December 29, 2003 Alternating constipation and diarrhea refers to a state whereby a patient is constipated for a period of time, typically 2-5 days, after which they experience (often explosive) diarrhea for a day or so, followed again by constipation. The cycle can continue for some time and is most usually associated with Liver Spleen disharmony. Because of the dynamic nature of the relationship between the Liver and Spleen, the symptom picture and predominance of constipation or diarrhea can change considerably depending on several factors - diet, stress and activity levels, weather etc. The typical development I see in clinic is from a predominance of qi stagnation and tendency to constipation, (most commonly in sedentary workers in less than satisfactory, but pressured, jobs), to gradual weakening of the Spleen and mild onset of occasional diarrhea or loose stools following episodes of constipation, to increasing diarrhea and a more established alternating pattern with pain. Many of the patients experiencing this exacerbate the Spleen decline by using bitter cold laxatives such as over the counter senna, but of course diet, inactivity and general stress levels all contibute. The more the Spleen is involved the more predominant the tendency to diarrhea. Usually diagnosed as irritable bowel, either of the constipation of diarrhea predominant variety. Constipation and diarrhea can also occur together, but in my experience it tends to be a rather specialised situation, where an elderly or bedridden patient has watery diarrhea (sometime to the point of incontinence) and abdominal pain, but has a constipated stool around which the fluids are being forced. The stool can be palpated in the left iliac fossa. Known as 'spurious diarrhea'. Will Maclean Quote Link to comment Share on other sites More sharing options...
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