Damp-Heat in the Large Intestine

Large Intestine PatternFull (Excess) Pattern

Clinical Presentation

Abdominal pain that is not relieved by a bowel movement, abdominal fullness, diarrhoea, mucus and blood in stools, offensive odour of stools, burning in the anus, scanty dark urine, fever, sweating which does not decrease the fever, a feeling of heat, thirst without the desire to drink, a feeling of heaviness of the body and limbs.

Tongue: Red with sticky yellow coating. Pulse: Slippery-Rapid.

Important symptoms: abdominal pain, diarrhoea with mucus and blood in the stools.

Arises from: Spleen-Qi deficiency is a very frequent pathological factor of this pattern as it predisposes the patient to the formation of Dampness.

Typically develops into: First of all, Damp-Heat in the Large Intestine frequently leads to Damp-Heat in the Small Intestine. The obstruction of the Lower Burner by Dampness may induce a deficiency of Spleen-Qi.

Easy clinical tip: Abdominal pain and diarrhoea with mucus and blood in the stools are enough to diagnose Damp-Heat in the Large Intestine.

Treatment

Principle: clear Heat, resolve Dampness, stop diarrhoea

SP-9 ↓With SP-6, resolves Dampness from the Lower Burner.

SP-6 ↓With SP-9, resolves Dampness from the Lower Burner.

Ren-3 ↓With BL-22, resolves Dampness from the Lower Burner.

BL-22 ↓With Ren-3, resolves Dampness from the Lower Burner.

ST-25 ↓Front-Collecting point of the Large Intestine — stops diarrhoea.

ST-27 ↓Stops abdominal pain.

Ren-6 ↓Moves Qi in the lower abdomen, which helps resolve Dampness.

BL-25 ↓Clears Heat from the Large Intestine.

L.I.-11 ↓Clears Heat.

Ren-12 ↑With BL-20, tonifies the Spleen to resolve Dampness.

BL-20 ↑With Ren-12, tonifies the Spleen to resolve Dampness.

ST-37 ↓Lower Sea point of the Large Intestine — stops diarrhoea.

SP-10 ↓Stops bleeding.

Combination Points (and notes)

Bai Tou Weng Tang is a favourite herbal formula (with variations) for ulcerative colitis and Crohn's disease treated as this pattern — a useful clinical anchor even for an acupuncture-only practice, since it tells you what severity of disease this pattern is meant to cover.
A case history here makes an important methodological point: a condition affecting the Small Intestine from a Western medical viewpoint was diagnosed as Damp-Heat in the Large Intestine from a Chinese medical viewpoint — Yin-organ and Yang-organ patterns frequently co-occur, and there is no direct correspondence between Western disease entities and Chinese medicine organ patterns.

Heat in the Large Intestine

Large Intestine PatternFull (Excess) Pattern

Clinical Presentation

Constipation with dry stools, burning sensation in the mouth, dry tongue, burning and swelling in the anus, scanty dark urine.

Tongue: Thick yellow (or brown or black) dry coating. Pulse: Full-Rapid.

Important symptoms: dry stools, burning sensation in anus, thick yellow dry tongue coating.

Arises from: Stomach-Heat may be the pathological precursor of this pattern.

Typically develops into: Heat in the Large Intestine injures fluids and may lead to Yin deficiency of the Stomach and the Large Intestine.

Easy clinical tip: Dry stools, a burning sensation in the anus and a thick yellow dry tongue coating are enough to diagnose Heat in the Large Intestine.

Treatment

Principle: clear Heat in the Large Intestine and Stomach, promote Body Fluids

ST-25 ↓With BL-25 (Front-Collecting and Back-Transporting points of the Large Intestine respectively), clears Heat in the Large Intestine.

BL-25 ↓With ST-25, clears Heat in the Large Intestine.

L.I.-11 ↓Clears Heat in the Large Intestine.

ST-37 ↓Lower Sea point for the Large Intestine — clears Heat in this organ.

ST-44 ↓Clears Stomach-Heat.

L.I.-2 ↓Clears Heat in the Large Intestine.

SP-6 ↑With KI-6 and Ren-12, promotes Body Fluids.

KI-6 ↑With SP-6 and Ren-12, promotes Body Fluids.

Ren-12 ↑With SP-6 and KI-6, promotes Body Fluids.

Combination Points (and notes)

A clean two-group Method: reduce every Heat-clearing point, reinforce the three fluid-promoting points (SP-6, KI-6, Ren-12) — with the emphatic 'positively no moxa' instruction, since Heat is the entire driving mechanism here.
ST-25 and BL-25 are paired specifically as the Large Intestine's Front-Collecting (Mu) and Back-Transporting (Shu) points — a clean example of the Mu-Shu pairing principle applied to clear Heat from a single organ.

Heat obstructing the Large Intestine

Large Intestine PatternFull (Excess) PatternEmergency

Clinical Presentation

Constipation, burning in the anus, abdominal distension and pain which is worse with pressure, high fever or tidal fever (fever that rises in the afternoon), sweating especially on the limbs, vomiting, thirst, delirium.

Tongue: Thick dry yellow (or brown-black) coating, Red body. Pulse: Deep-Full.

Important symptoms: constipation, abdominal pain, fever, thick dry yellow coating.

Arises from: As this is the second stage of a febrile disease, it always derives from an invasion of exterior Wind which penetrates in the Interior and turns into Heat.

Typically develops into: As this pattern occurs during the second stage of an acute febrile disease, there are only three possible outcomes: the patient’s body’s Qi may react well and he or she recovers completely, the Heat may progress to the next stage, or the patient may appear to recover but there is a residual Heat left in the body. If this pattern corresponds to the Bright Yang organ pattern of the Bright Yang stage within the Six Stages, it may progress to one of the Yin stages; if it corresponds to the Intestines Dry-Heat pattern at the Qi level within the Four Levels, it may progress to the Nutritive Qi or Blood level.

Easy clinical tip: Constipation, abdominal pain, fever and a thick dry yellow coating are enough to diagnose Heat obstructing the Large Intestine.

Treatment

Principle: clear Heat in the Stomach and Large Intestine, promote bowel movement

L.I.-11 ↓Clears Heat in the Large Intestine.

L.I.-4 ↓Clears Large Intestine-Heat and promotes bowel movement.

SP-15 ↓Promotes bowel movement.

T.B.-6 ↓Clears Heat in the Intestines and promotes bowel movement.

SP-6 ↓Nourishes Yin and stops abdominal pain — needled with the pattern's overall reducing method despite its Yin-nourishing action.

L.I.-2 ↓Clears Large Intestine-Heat.

ST-44 ↓Clears Stomach-Heat.

ST-25 ↓With BL-25, clears Large Intestine-Heat.

BL-25 ↓With ST-25, clears Large Intestine-Heat.

Combination Points (and notes)

This is the most severe pattern on this deck — high or tidal fever with delirium marks genuine Yangming Fu-organ Excess-Heat, a step beyond plain Heat in the Large Intestine, and worth treating with the same urgency as an internal-medicine emergency.
Unlike Heat in the Large Intestine (which explicitly splits into a reduce group and a reinforce group), here the Method states simply 'reducing, no moxa' with no named exception — so SP-6 is reduced despite its Yin-nourishing description, a useful point to flag when teaching how literally to follow a stated Method line.

Cold invading the Large Intestine

Large Intestine PatternFull (Excess) PatternExternal Pattern

Clinical Presentation

Sudden, cramping abdominal pain, diarrhoea with pain, feeling of cold, cold sensation in the abdomen.

Tongue: Thick white coating. Pulse: Deep-Tight.

Important symptoms: sudden abdominal pain, diarrhoea, feeling of cold.

Arises from: Liver-Qi stagnation is a frequent precursor of this pattern.

Typically develops into: Cold in the Large Intestine may injure Yang and lead to Spleen-Yang deficiency.

Easy clinical tip: Sudden abdominal pain, diarrhoea and a feeling of cold are enough to diagnose Cold invading the Large Intestine.

Treatment

Principle: expel Cold from the Large Intestine, warm the Lower Burner

ST-37 ↓Lower Sea point of the Large Intestine — stops diarrhoea and pain.

ST-25 ↓Front-Collecting point of the Large Intestine — stops diarrhoea and pain.

ST-36 ↓With moxa on the needle, expels Cold from the Large Intestine.

SP-6 ↓Stops abdominal pain (standard action, not individually named for this pattern).

LIV-3 ↓Promotes the smooth flow of Liver-Qi and relieves spasm (standard action, not individually named for this pattern).

ST-27 ↓Local abdominal point — stops abdominal pain (standard action, not individually named for this pattern).

Combination Points (and notes)

Moxa is applied directly on the needle at ST-36 despite the overall reducing method — a clean example of warming a Cold component while still reducing the Excess obstruction itself, the same logic seen in Cold-Dampness invading the Spleen.
The Explanation for this pattern only spells out ST-37, ST-25 and ST-36 by name even though SP-6, LIV-3 and ST-27 are listed among the points — their actions above follow each point's standard function rather than a missing sentence, and are worth double-checking against the original text.

Qi Stagnation in the Large Intestine

Large Intestine PatternFull (Excess) Pattern

Clinical Presentation

Abdominal distension and pain, constipation with bitty stools, irritability, aggravation of the condition according to mood.

Tongue: Either normal or slightly Red on the sides. Pulse: Wiry on both Rear positions.

Important symptoms: abdominal distension and pain, bitty stools.

Arises from: Liver-Qi stagnation is a frequent precursor of this pattern.

Typically develops into: If it is not the precursor, Liver-Qi stagnation may derive from this Qi stagnation in the Large Intestine. Qi stagnation in the Large Intestine may also lead to the formation of Dampness as the stagnant Qi fails to move and transform fluids.

Easy clinical tip: Abdominal distension and pain with bitty stools are enough to diagnose Qi stagnation in the Large Intestine.

Treatment

Principle: move Qi in the Large Intestine

Ren-6 ↓In combination with G.B.-34, moves Qi in the lower abdomen.

G.B.-34 ↓In combination with Ren-6, moves Qi in the lower abdomen.

ST-25 ↓Moves Qi in the Large Intestine.

SP-15 ↓Moves Qi in the Large Intestine and promotes the bowel movement.

ST-37 ↓Lower Sea point of the Large Intestine — regulates Qi of the Large Intestine, particularly indicated in chronic conditions.

SP-6 ↓Stops abdominal pain.

BL-25 ↓Moves Qi in the Large Intestine.

Combination Points (and notes)

This pattern is explicitly linked to Liver-Qi stagnation as its precursor — aggravation according to mood is the key clue that emotional factors, not diet or Cold, are driving the bowel symptoms.
ST-37 is specifically called out for chronic conditions — worth adding to the base point set once bitty-stool constipation with distension has become a long-standing pattern rather than a recent onset.

Large Intestine Dry

Large Intestine PatternEmpty (Deficiency) Pattern

Clinical Presentation

Dry stools which are difficult to discharge, dry mouth and throat, thin body, foul breath, dizziness.

Tongue: Dry, either Pale or Red body with rootless coating. Pulse: Fine.

Important symptoms: dry stools which are difficult to discharge, thin body.

Arises from: Usually this pattern is preceded by a deficiency of Qi of the Stomach and the Large Intestine.

Typically develops into: Yin deficiency of the Stomach and Large Intestine is the common pathological consequence of Dryness.

Easy clinical tip: Dry stools without other notable symptoms are enough to diagnose Large Intestine Dry.

Treatment

Principle: promote fluids in the Large Intestine

ST-36 ↑Promotes fluids in the Stomach and Large Intestine.

SP-6 ↑With Ren-4, tonifies Yin and promotes fluids.

Ren-4 ↑With SP-6, tonifies Yin and promotes fluids.

KI-6 ↑Tonifies Yin and promotes fluids — particularly indicated to moisten the stools.

ST-25 ↑Moistens the Intestines.

SP-15 ↑Moistens the stool and treats constipation.

Combination Points (and notes)

The diagnostic tip is unusually minimal here — dry stools alone, without other notable symptoms, are enough to diagnose this pattern — a reminder that not every pattern needs a long symptom list to be clinically recognizable.
This is purely about fluids and Yin, with no Heat component at all (unlike Heat in the Large Intestine, which also causes dry stools) — the tongue confirms this: it can be either Pale or Red, but always carries a rootless coating rather than the thick yellow coating of a Heat pattern.

Large Intestine Cold

Large Intestine PatternEmpty (Deficiency) Pattern

Clinical Presentation

Loose stools like duck droppings, dull abdominal pain, borborygmi, pale urine, cold limbs.

Tongue: Pale. Pulse: Deep-Weak.

Important symptoms: loose stools, dull abdominal pain, cold limbs.

Arises from: Spleen-Yang deficiency is nearly always the precursor of this pattern.

Typically develops into: If this pattern does not derive from Spleen-Yang deficiency, it may itself be the precursor of it.

Easy clinical tip: Loose stools, dull abdominal pain and cold limbs are enough to diagnose Large Intestine Cold.

Treatment

Principle: tonify and warm the Large Intestine and Spleen

ST-25 ↑Stops diarrhoea and pain. The warm box can be used on this point and Ren-6.

Ren-6 ↑Tonifies Qi and stops chronic diarrhoea. The warm box can be used on this point and ST-25.

ST-36 ↑Tonifies Spleen-Qi.

ST-37 ↑Stops chronic diarrhoea.

BL-25 ↑Back-Transporting point of the Large Intestine — tonifies this organ and stops diarrhoea.

BL-20 ↑Tonifies Spleen-Qi.

Combination Points (and notes)

'Loose stools like duck droppings' is a vivid, memorable clinical image worth keeping verbatim when teaching this pattern — distinct phrasing from the more generic 'loose stools' used elsewhere.
The warm box (a moxa box rather than moxa cones or needle-moxa) is specifically named for ST-25 and Ren-6 — a good example of specifying not just that moxa should be used, but which delivery method.

Collapse of Large Intestine

Large Intestine PatternEmpty (Deficiency) Pattern

Clinical Presentation

Chronic diarrhoea, prolapse ani, haemorrhoids, tiredness after bowel movements, cold limbs, no appetite, mental exhaustion, desire to drink warm liquids, desire to have the abdomen massaged.

Tongue: Pale. Pulse: Deep-Fine-Weak.

Important symptoms: chronic diarrhoea, prolapse ani.

Arises from: Sinking of Spleen-Qi is always the precursor of this pattern.

Typically develops into: Collapse of the Large Intestine may affect other organs in the Lower Burner and particularly the Bladder and it may lead to sinking of Qi affecting the bladder.

Easy clinical tip: Chronic diarrhoea and prolapse ani are enough to diagnose Collapse of the Large Intestine.

Treatment

Principle: tonify Stomach and Spleen, raise Qi

Ren-6 ↑Tonifies and raises Qi. The warm box could be used on this point and ST-25.

ST-25 ↑Tonifies the Large Intestine and stops diarrhoea. The warm box could be used on this point and Ren-6.

ST-36 ↑Tonifies Stomach- and Spleen-Qi.

SP-3 ↑Tonifies Spleen-Qi.

BL-20 ↑With BL-21, tonifies Spleen and Stomach.

BL-21 ↑With BL-20, tonifies Spleen and Stomach.

Du-20 ↑With direct moxa, raises Qi — used for prolapse ani.

Combination Points (and notes)

This is the end-stage of the Large Intestine's Deficiency spectrum here — the same Ren-6/ST-25 warm-box pairing seen in Large Intestine Cold reappears here, with Du-20 added specifically once actual prolapse (not just loose stools) has developed.
The desire to have the abdomen massaged, alongside desire for warm liquids, mirrors the pain-relieved-by-pressure pattern seen in Small Intestine Deficient and Cold — a shared signature of Deficiency-Cold abdominal patterns across different organs.

Large Intestine Patterns — At a Glance

Diagnostic Tip, Pattern by Pattern

Damp-Heat in the Large Intestine	Abdominal pain and diarrhoea with mucus and blood in the stools.
Heat in the Large Intestine	Dry stools, a burning sensation in the anus and a thick, yellow, dry tongue coating.
Heat obstructing the Large Intestine	Constipation, abdominal pain, fever and a thick, dry, yellow tongue coating.
Cold invading the Large Intestine	Sudden abdominal pain, diarrhoea and a feeling of cold.
Qi stagnation in the Large Intestine	Abdominal distension and pain with bitty stools.
Large Intestine Dry	Dry stools which are difficult to discharge, thin body.
Large Intestine Cold	Loose stools, dull abdominal pain, cold limbs.
Collapse of Large Intestine	Chronic diarrhoea and prolapse ani.

How to Think About It (reasoning framework)

A case history here makes an important methodological point worth repeating to students: a condition that would be diagnosed as a Small Intestine disease from a Western medical viewpoint was diagnosed as Damp-Heat in the Large Intestine from a Chinese medical viewpoint — there is no direct correspondence between Western disease entities and Chinese medicine organ patterns.
The four Full/Excess patterns (Damp-Heat, Heat, Heat obstructing, Cold invading, Qi stagnation) share pain and disrupted bowel movements as Excess signs, while the three Empty patterns (Dry, Cold, Collapse) share weakness and constitutional signs (thin body, cold limbs, mental exhaustion) — use that Full-vs-Empty split as the first branch point before narrowing further.