Digestive Issues

This vocabulary and these questions apply no matter which of the six conditions below you're looking at — read it once, then jump straight to a condition.

Four distinct sensations, each pointing to a different pathology. Western patients will rarely use these exact words — "distension" usually comes out as "bloating," "bursting" or "being blown up."

Where the distension is narrows it further:

• Liver-Qi stagnation — epigastric/abdominal, clearly tied to emotional state. Pulse Wiry (or Wiry left).
• Stomach-Qi stagnation — epigastric, not emotion-related, eased by burping. Pulse Wiry on the right Guan.
• Spleen-Qi stagnation — lower abdominal, loose stools, eased by passing gas and rest. Pulse slightly Wiry left, Weak right.
• Intestinal Qi stagnation — abdominal distension and pain, borborygmi, constipation, eased by passing gas. Pulse Wiry on both Chi.

Points — epigastric distension: Ren-10, Ren-12, ST-21, ST-34, ST-40, G.B.-34. Lower abdominal distension: ST-25, SP-15, G.B.-34, Ren-6. Oppression of the chest: Ren-17, P-6, LU-7, ST-40.

• Diet — sugar, sweets, dairy → Dampness or Phlegm. Cold foods/drinks/raw food → Cold in Stomach or Intestines. Spicy food and alcohol → Heat in Stomach or Intestines.
• Irregular eating — eating in a hurry, at the desk, standing, while working, or late at night → Stomach-Yin deficiency. Points: Ren-12, ST-36, SP-6.
• Anger — affects Liver and Heart; rebellious Liver-Qi invades Stomach and/or Spleen. Expressed anger tends to hit the Stomach (Qi rebels horizontally — nausea, belching, acid regurgitation); repressed anger tends to hit the Spleen (Qi stagnation — loose stools).
• Worry / pensiveness — affects the Liver (→ Liver-Qi stagnation affecting Stomach/Intestines) and the Spleen (→ loose stools, abdominal pain and distension).
• Guilt — affects the Liver, causing Liver-Qi stagnation → epigastric or abdominal pain.

Pulse: both Rear positions reflect the Intestines. If both Rear positions share the same abnormal quality, the origin is intestinal; if only one side does (usually the left, in women), suspect a gynaecological origin instead.

• Tight and Slow — Cold in the Intestines.
• Wiry — Qi or Blood stagnation in the Intestines.
• Wiry-Rapid-Slippery — Damp-Heat in the Intestines, possibly with bleeding (often seen in Crohn's disease or ulcerative colitis).
• Wiry-Hollow — prolonged intestinal bleeding.
• Rapid, only slightly Hollow — forthcoming intestinal bleeding.
• Slippery-Wiry — Damp-Heat with Qi or Blood stagnation.

The source also names Cold invading the Stomach, Retention of Food, Stomach-Heat, Stomach-Fire, Stomach and Liver Heat, Stasis of Blood in the Stomach, and Phlegm-Fluids in the Stomach as further Excess causes of epigastric pain, without giving full clinical detail in this course. For those, see the Stomach Patterns Deck.

A functional GI disorder — frequent symptoms without structural damage to the gut. Diagnosed when abdominal pain/discomfort occurs at least 3 times a month for at least 3 months, with a change in stool frequency/consistency, in the absence of other explanatory disease. Four Western subtypes based on stool pattern: IBS-C (constipation-predominant), IBS-D (diarrhoea-predominant), IBS-M (mixed), IBS-U (neither predominant).

In Chinese medicine, IBS isn't one disease — it overlaps three: Abdominal Pain, Diarrhoea and Constipation. In practice it's usually a combination of three patterns in varying proportion:

The lower oesophageal sphincter normally prevents stomach contents rising back into the oesophagus; when it doesn't close properly, acidic contents reflux upward. Main symptoms: heartburn (worse at night, bending, lying down or eating; relieved by antacids), belching, acid regurgitation, difficulty swallowing — sometimes linked to a hiatus hernia. Risk factors: pregnancy, obesity, fat/chocolate/coffee/alcohol, large meals, smoking, certain drugs, systemic sclerosis.

GERD doesn't map to one Chinese disease — its symptoms are spread across six classical entities:

Memory aid — "no sail, no wind, no water": a boat needs a sail (Qi/Yang) to be pushed, wind (Qi flow) to move it, and enough water (Blood/Yin) to float on. Missing any one of the three gives a different root cause of constipation:

How each organ contributes:

• Stomach — its Qi descends and helps move the stools; as the source of fluids, deficiency here can also cause constipation.
• Large Intestine — receives fluids from the Small Intestine, reabsorbs some, and excretes the stool.
• Spleen — although Spleen-Qi ascends, it also governs transportation/transformation (yun hua); deficient Spleen-Qi can fail to move the stools.
• Liver — Liver-Qi affects the Intestines and helps move the stools.
• Kidneys — deficient Kidney-Yang can fail to move the stools; deficient Kidney-Yin causes dryness in the Intestines.
• Lungs — control Qi and are paired with the Large Intestine; deficient Lung-Qi may fail to descend to the L.I., usually in the elderly.

An inflammatory bowel disease affecting the lining of the large intestine and rectum (Crohn's disease is related but distinct); cause unknown, autoimmune-associated. Two age peaks: 15–30 and 50–70. Can start in the rectum and spread through the colon. Risk factors include family history and Jewish ancestry. Symptoms: abdominal pain and cramping, gurgling/splashing sounds, blood and mucus in the stools, diarrhoea of variable frequency, fever, tenesmus (rectal pain), weight loss, slowed growth in children.

In Chinese medicine, UC maps onto: Dysentery (Li Ji), Diarrhoea (Xie Xie), Blood in the Stools (Bian Xue), Intestinal Wind (Chang Feng), Intestinal Pi Masses (Chang Pi).

Pathology — six contributing factors, usually in combination:

• Deficiency of Stomach and Spleen — almost always present; Spleen deficiency itself can cause the diarrhoea, and can also cause bleeding.
• Dampness (especially Damp-Heat) — always present; obstructs the Intestines and can itself cause diarrhoea.
• Qi stagnation — nearly always present; causes borborygmi and distension.
• Blood stasis — develops from Qi stagnation; causes intense pain.
• Toxic Heat — develops from Damp-Heat; present in acute cases or flare-ups.
• Blood Heat — develops from Damp-Heat; causes bleeding.

Essential points for all cases: ST-25, BL-25, ST-37, ST-39. (The source doesn't specify reinforcing/reducing method for this condition's points — use standard judgement based on each pattern's Empty/Full nature.)