Digestive disorders
Common digestive disorders
Many patients who come for Tui na treatment have digestive problems as part of their presentation. Common complaints include:
•Irritable bowel syndrome (IBS)
•Constipation
•Diarrhea
•Epigastric pain
•Abdominal pain
•Acid reflux
•Belching and flatulence
•Hypochondriac pain
•Poor appetite
Factors in common digestive disorders
The causes of these ailments are generally a combination of factors such as dietary inadequacies and excesses, irregular eating patterns, overwork and stress. Any combination of these lifestyle factors can lead to deficiency of Qi, Blood, Yin and Yang and to stagnation of Qi and accumulation of Heat, Cold and Damp.
Other factors in common digestive disorders
The small intestine
Sometimes known as the abdominal brain, the small intestine sits at the foot of the heart, sifting and sorting, absorbing what is useful, and passing on what is not to the large intestine and bladder to be excreted. This applies to thoughts and emotions as well as to nutrients. If you practice in a big city as I do, patients often report feeling overwhelmed, having too much to do, too much work, not enough time to reflect; they feel pushed by the general energy around them and find it very difficult to relax. Generally, there is a feeling of being hyper-stimulated. In attempting to deal with all of this mental and emotional energy information, the small intestine, and consequently the large intestine, can become tense, tight and knotted, much in the same way as our shoulders develop tension and congestion when we are stressed and pushing our Qi too hard.
On palpation, the small intestine should feel soft and move easily and painlessly; often however, it feels tight, knotty and uncomfortable on palpation. As well as affecting the digestion, knotted and compromised intestines can lead to various problems such as menstrual disorders, emotional problems and back pain. Tui na is very effective for releasing these areas of stagnation and accumulation.
Suggested methods for releasing stagnation of Qi manifesting as accumulation, adhesion and knotting in the abdomen
The abdomen is a sensitive area and this work can get quite deep and be a bit uncomfortable both physically and emotionally. Always start by working initially on the patient’s back and chest. Old traumas can be held in the small intestine, particularly around the navel, and powerful release work can be done by freeing up the accumulated and stagnant emotional Qi. The following method is suggested:
•Start with Mo fa using the pads of your index, middle and ring fingers. Work from the navel out in small anti-clockwise circles.
•Moving slightly deeper, work in the same manner as above using Rou fa, feeling for areas of knotting, tightness and congestion and asking your patient to let you know of any tender or painful areas. Apply this three times.
•Go back to the knotted areas that you found and begin to disperse them with fast anti-clockwise Rou fa, Zhen fa and Ji dian fa.
•With both palms over the area of the small intestine, apply Rou fa in a wave-like motion, as if rolling a ball that is inside the patient’s belly, between your hands.
•Bring the ulnar edge of your palms to beneath the patient’s ribcage, fingers just below the sternum, and use Rou fa to release the diaphragm, thinking of drawing it down towards the navel.
The navel
Ren8 – ‘spirit door’ – is a place that can provide an exit for stagnant accumulated pathogenic Qi. Releasing the area around the navel will help to release both physical and emotional traumas. The suggested method is as follows:
•Apply Ji dian fa and Zhen fa to the area all around the navel.
•Imagine eight doorways around Ren8, all 0.5 cun away. Think of them as representing the eight directions of a compass. Starting from the east at the doorway that corresponds to KD16 on the right, work around these points using An fa and Rou fa. Work with your patient’s breath, applying pressure with their exhalation to take you to the Ying Qi level, maintain the pressure at that level and apply anti-clockwise Rou fa, gradually kneading up to the Wei Qi level at the surface. Your intention is to draw the pathogenic Qi up and out of the body through the navel. Apply this method three times, dispersing with Zhen fa, Ji dian fa and Pai fa in between. The third time when you have pressed down into the Ying Qi level, maintain the pressure and stretch the underlying tissue slightly by pushing your thumb away from the navel. Ask your patient to breathe into the pressure then, as before, use anti-clockwise Rou fa to draw up to the Wei Qi level.
Working under the ribs
To help release the diaphragm, move stagnation in the Middle Jiao, and improve the functions of the lungs, liver, gallbladder, stomach and spleen, the suggested method is as follows:
•Work under the ribs, moving gradually from the area of Liv13 on the right to Liv13 on the left using An fa and Rou fa with both thumbs. Work with your patient’s breath, applying pressure with their exhalation. To provide deeper stimulation, ask your patient to breathe deeply into your pressure a few times.
General tips for treating digestive problems
•Work on the back first, the Governing Vessel, Bladder channel, sacrum and hips, any relevant Back Shu points, Governing Vessel or Huatuojiaji points.
•Work distally on the appropriate leg, and sometimes the arm channels, stimulating your chosen distal points as you work.
•Work the chest and ribs to soothe and disperse Qi using the basis of the area foundation routine.
•Work the abdomen last.
•Use the simple abdominal routine as a basis for your local work.
•If on palpation of the abdomen you found knots, adhesion and accumulation, consider using some of the abdominal release work.
To help you plan a Tui na treatment for digestive ailments, see Table 12.1 for some suggestions of useful techniques to consider including in the treatment of common patterns of disharmony.
Case studies
To help illustrate the treatment of digestive ailments, three cases of patients I have treated follow.
Excessive belching and hypochondrial pain
Main complaint
Avi, a 38-year-old actor, had been suffering with what he described as excessive belching for the previous 18 months. He said he wanted to belch all the time, but he could usually control it if he was in public. When he was alone he was belching almost constantly. Recently it had become worse and he was starting to notice it when he was on stage. It was making him really angry. He told me straight away that he did not really believe in complementary medicine but the doctor could not find anything wrong with him and a friend had recommended me so he thought he would try it for a few sessions to see if it made any difference.
The belching was very loud and worse after eating. He had a distending pain under his ribs that came and went and was worse when he was stressed.
Secondary complaints
He had an oppressive feeling in his chest and found himself sighing and yawning frequently to ease the sensation. He also had a feeling of restriction in his throat as if something was stuck there. Emotionally he was very frustrated both with his acting career and with his family.
Palpation and observation
Avi had a wiry build and he looked tense. On palpation, the area under his ribs was Full and tender on pressure and there was tenderness at Liv14. The area around his navel was congested and knotted.
Tongue
His tongue was normal.
Pulse
His pulse was Wiry.
Diagnosis
The diagnosis was stagnation of Liver-Qi invading the Stomach.
Treatment principle
This was to disperse stagnant Qi, soothe the Liver and descend rebellious Stomach-Qi.
Treatment
With the patient lying prone
•Tui fa and Rou fa along the Bladder channel from the nape to the sacrum
•Compound technique pinching–grasping along the Bladder channel from the nape to the sacrum three times on each side
•Double-handed Gun fa along the Bladder channel to the level of the waist
•Tan bo fa over the paraspinal muscles from BL17 to BL21
•Yi zhi chan tui fa to stimulate BL17, BL18 and BL19
•Three-finger Ji dian fa from BL17 to BL21 using medium rhythmic striking
•Ya fa plus Rou fa to stimulate GB30
•Tui fa to dredge the Gallbladder channel
With the patient supine
•Yi zhi chan tui fa to stimulate Liv3, GB34, SJ6 and PC6
•Pinching–grasping, kneading–grasping, nipping– grasping, loose-fist Pai fa and five-finger Ji dian fa to the Liver and Gallbladder channels in his legs and the San Jiao and Pericardium channels in his arms to move Qi and dissipate stagnation
•Tui fa, Ji dian fa and Zhen fa to his chest
•Compound technique, pushing–pressing in the axilla and the subclavicular fossa
•Compound technique, kneading–grasping to his pectoral muscles
•An fa to stimulate ST12
•Tui fa and Rou fa to his ribs
•Yi zhi chan tui fa to stimulate Liv14 and Ren12
•Palm Zhen fa over Liv14 and Ren12
•Tui fa, forearm Rou fa and Mo fa to his abdomen
•Compound technique, lifting–grasping over his ribs and to his abdomen
•Ji dian fa around his navel
•Whisking–sweeping and Ca fa to his ribs
I suggested to Avi that he reduce his coffee intake. He was drinking six strong cups a day. He was not getting enough exercise as far as he was concerned; he used to enjoy running but had got out of the habit. I encouraged him to take up running again as I thought it would help to move his Qi.
Progress and subsequent treatment
I gave Avi a total of six weekly treatments. After three treatments, things began to change. The plum stone throat and oppressive feeling in his chest were the first symptoms to be alleviated. He was encouraged by the changes that he felt and said he thought that Tui na was doing him some good and would continue with this form of treatment. Over the 6 weeks I worked with the above treatment and added more abdominal release work under his ribs and around his navel, getting him involved by working with his breath. His belching and hypochondrial discomfort diminished each week. He relaxed and communicated more with each treatment. He was running again, and he was also meditating for 10 minutes every day (he had given this up a few years ago). When he came in for his sixth treatment, he sat back in the chair, smiled at me and told me that the treatment had worked. He had not belched all week and had no discomfort. He looked very different from the man I had met a few weeks before.
Constipation
Main complaint
Laura, aged 43, was suffering with constipation and tiredness. She felt bloated and uncomfortable in her abdomen most of the time. Her stools were hard, dry and infrequent (about twice a week). The previous few years had been very stressful; she had had two miscarriages over this time. She was very tired, especially in the morning and around her period. I distinctly got the impression that she was holding on to a lot of emotion and had become accustomed to being ‘very nice’ in order to protect herself.
Secondary complaints
She had temporal and vertical headaches, especially premenstrually and during her period which was regular but had become very light over the past year. She had floaters most of the time, dizziness when she was hungry and on the first day of her period, and dry skin. She had also been having a lot of lower backache for the previous 12 months and had been seeing an osteopath for treatment of this. She urinated frequently (every hour) during the day. Generally she felt cold easily and her hands were cold.
Palpation and observation
There was general tenderness in the lower left side of her abdomen and at Liv13 and ST25. There were several areas of knotting in her lower abdomen.
Tongue
Her tongue was pale and dry.
Pulse
Her pulse was Choppy.
Diagnosis
The diagnosis was Blood Xu leading to dryness and stagnation of Qi in the Intestines. Her Kidney-Yang was also Deficient.
Treatment principle
This was to disperse stagnation and encourage the movement of Qi in the Intestines, nourish Blood and warm Kidney-Yang.
Treatment
With the patient lying prone
•Tui fa along the Bladder channel from the nape to the sacrum gently and until warm
•Forearm Rou fa over BL14, BL17, BL20 and BL23
•Gun fa from BL23 to BL25
•Ca fa across the lower back
With the patient supine
•Tui fa and Mo fa slowly and gently along the Yin channels of the legs following the flow of the primary meridians
•An fa and clockwise Rou fa slowly and gently to stimulate Liv3, Liv8, SP6 and ST36 focusing on pushing into the Ying Qi level
•Tui fa across her chest and ribs
•An fa and Rou fa in the intercostal spaces
•Mo fa over her lower ribs focusing on Liv13
•Tui fa, tai chi Mo fa and palm Rou fa to her abdomen for 10 minutes, focusing on Ren12, ST25 and Ren4 with clockwise palm Rou fa
•Zhen fa over Ren4
•Cat’s paw across her abdomen
Ancillary therapies
Direct moxa was used in the form of three small cones on BL17, BL19, BL20, BL23 and Ren4.
Advice to the patient
I showed Laura how to breathe into her belly and how to apply some simple self-massage to her abdomen.
Progress and subsequent treatments
Over the next few treatments I began to introduce some of the abdominal release work to clear the knotted areas that I had found. This proved to be very effective. (This work keeps the patient working with you; as you encourage them to breathe into areas of accumulated Qi, their awareness and breath begin to release what has been held.) Memories and emotion surfaced as we worked together over the next few weeks and her bowel movements started to come more frequently, her energy levels started to rise and her backache was much improved. I worked with Laura weekly for 12 weeks. In the second half of her menstrual cycle I continued with release work on her abdomen and some deeper work in her sacrum and hips with Ya fa and Rou fa, encouraging Qi to move. During her period I worked more on her back and distally and very simply on her belly with Mo fa, Zhen fa and warming palm. In the postmenstrual week, I worked very gently with the treatment described above without any release work.
Gradually I showed Laura more abdominal work that she could do herself between treatments; this makes a huge difference when you are limited to treatments once a week or less.
By the end of the 12 weeks, Laura had gone through quite a transformation. She was having regular daily bowel movements that were normal in shape and no longer dry, she had no backache or headaches and she felt generally warmer. She said her energy was back to how it was before she had her children; she felt positive in herself and had started playing the cello again which she had not touched for over 7 years. I still see Laura once a month for maintenance treatment.
Diarrhea
Main complaint
David, aged 46, had been suffering with diarrhea for the previous 5 years. His stools were very loose, watery and urgent. The diarrhea started from the time he woke up in the morning and was accompanied by some abdominal pain; it lasted until about midday after which he was okay. On average, he would have to go to the toilet six or seven times every morning. Getting to work on the train was becoming a nightmare; he knew every toilet en route and had to stop at least twice on the way. He was very stressed and anxious about it. His appetite was up and down and he often felt bloated. He had stopped eating breakfast in case it made his morning diarrhea worse. He craved sweet things and ate pasta several times a week but generally his diet was quite good.
He had been made redundant from a job that he loved 6 years before and was dissatisfied and unfulfilled in his current work. He was constantly worrying and trying to work out what he should do.
Secondary complaints
David felt easily tired. He had lower backache from time to time. Other than that he was in good health.
Palpation and observation
His abdomen was cold to the touch. Ren12 and Ren6 felt very Empty on pressure.
Tongue
His tongue was pale with scallops and with a thin white coating.
Pulse
His pulse was Weak and Deep.
Diagnosis
The diagnosis was Spleen- and Kidney-Yang Xu.
Treatment principle
This was to warm and strengthen Kidney- and Spleen-Yang, stop the diarrhea and calm the mind.
Treatment
With the patient lying prone
Using red flower balm I applied:
•Tui fa along the Governing Vessel from Du2 to Du14 until warm
•Palm Ya fa up the Governing Vessel followed by clockwise palm Rou fa
•Tui fa and palm Rou fa along the Bladder channel from the nape to the sacrum
•Compound technique, pinching–grasping along the Bladder channel from the nape to the sacrum three times on each side
•Gun fa along the Bladder channel, concentrating on the areas of BL20 and BL23 until they were very warm. I coordinated this with An fa and Tui fa down the backs of his legs along the Bladder channel
•Yi zhi chan tui fa on BL20, BL23 and BL25, followed by forearm Rou fa
•Compound technique, lifting–grasping along the Governing Vessel from Du2 to Du14 ten times
•Ca fa across Du4 and Du14
•Ca fa to KD1
With the patient supine
•Tui fa and Rou fa on his legs, working down the Stomach and up the Spleen channels until warm. An fa to stimulate KD3 and SP6 focusing on pushing Qi up the channels into the Kidney and Spleen
•Ca fa along the Yin channels of the legs until hot
•Yi zhi chan tui fa on ST36
•Tai chi Mo fa to his abdomen in an anti-clockwise direction for 5 minutes
•Forearm Rou fa clockwise over Ren12, ST25 and Ren6 plus Gun fa down his legs along the Stomach channel
•Palm An fa and Rou fa over Ren12, ST25, Ren8 and Ren6. At the same time I applied An fa to Du20 with my left thumb
•Palm Zhen fa over the above points
To finish
I applied warming palm with one palm over Ren8 and the other over his forehead with the intention of calming his Shen.
Ancillary therapies
I used moxa on ginger at Du4, BL23, BL20 and Ren12, and moxa on salt at Ren8, with three substantial cones on each point.
Advice to the patient
I advised David to drink some ginger tea in the morning to warm his Stomach- and Spleen-Qi and encouraged him to start eating breakfast again. I suggested that he ate more short grain organic brown rice and less pasta. I also showed him how to apply moxa with a moxa stick to KD3 and Ren12 and suggested that he did this every day between treatments as he could only come weekly.
Progress and subsequent treatments
I continued to treat David weekly as described above for 10 weeks, often finishing treatment with warming palm over his head, eyes, abdomen or lower back and some gentle work on his face and head to calm his Shen. David continued to use moxa between treatments and I showed him how to apply some simple massage to his abdomen and lower back and some Qigong exercises to help to strengthen his Spleen- and Kidney-Qi. After 5 weeks David had noticed some significant improvements. He was going to the toilet three times in the morning and his stools, although still loose, were no longer watery and were less urgent. He was feeling generally more in control. After 10 weeks, he was passing soft but formed stools twice a day, once in the morning and once after lunch without any urgency; he had no abdominal bloating or discomfort. He was no longer tired and said he was beginning to feel quite stable in himself. His tongue was less pale and the scallops almost entirely gone. His pulse was stronger. I gave him two treatments a fortnight apart and then three monthly treatments to maintain and further the progress. He now comes for treatment about twice a year, just for an ‘MOT’ as he calls it.