The health of your Colon (or Large Intestines) is not something that should be overlooked. The organ holds the job of letting go of things it no longer needs, both literally and mental and emotionally. The number of cases of colon diseases including cancer are rising at an alarming rate. Colon health is something that is often overlooked in general wellness education, sometimes shunned because of stigmas around being ‘unclean’ or simply shoved aside as ‘not that important’. I see this last mindset as something comes up with many fad diet especially those cut out fiber rich diets or utilize a lot of smoothies and shakes. Great – I’ve jumped ahead again.
A bit of semantics first. In Asian medicine (Chinese medicine) books and charts it’s not uncommon to run across differing naming and abbreviations for organs and channels. Depending on the book or the reference material used the author or creator may have used Li for Liver as opposed to LV and/or LI may have been used for Large Intestines. The font used may also add further confusion. It can leave new students a little frustrated. I was originally taught to use the word Colon when referring to the Large Intestines – and though I use both for the sake of clarity I most often use Colon (CO). I use lower case letters when I’m speaking about the organ from a western medical perspective and capitalize it when speaking of the organ from Asian medicine terms. Enough with semantics.
A little colon anatomy from the eyes of Western medicine
The colon is about 1.5 meters long and has several distinct regions. The ascending colon travels up the right side of the abdominal cavity to the level of the right kidney. Here it makes a right-angle turn at the right colic (hepatic flexure) and then travels across the abdominal cavity as the transverse colon. At the spleen, it bends acutely at the left colic flexure and descends down the left side of the posterior abdominal wall as the descending colon. It then enters the pelvis, where it becomes the s-shaped sigmoid colon. In the pelvis the sigmoid colon joins the rectum, which runs just in front of the sacrum. The anal canal, the last segment of the large intestine, is about 3 cm, long and begins where the rectum penetrates the levator ani muscle of the pelvic floor and it opens to the body exterior at the anus.
The major functions of the colon in Western medicine terms
- Salvages water and reabsorbs chyme (food stuff passed from the small intestines)
- Excrete feces
- Helps regulate water metabolism
During the digestive process the stomach and small intestines add fluid to the food product creating something called chyme. Chyme is 95% water when it enters the colon. It’s the colon’s job to properly reabsorb what fluids it can to turn the chyme into a relatively solid mass or feces. It does this through two types of movements.
- Haustral churning – Haustra are the little pockets along the colon that give it its puffy appearance. Once chyme enters the haustra they distend until full and then push the substance to the pushes to the next haustra – moving right along.
- Peristalsis – Is a slower process and occurs midway through the transverse colon and on the right side of the colon tract. The colon contracts about 3-12 per minute, moving as a large wave through the transverse colon to the rectum. Once the rectum is full and distended there should be an urge to defecate. Over-control or perpetuated disregard for the urge to defecate can lead to inability to recognize the need to defecate and create bowel problems. Peristalsis is triggered by chewing and by food entering the stomach to trigger the gastrocolic reflex. This is another reason why it is so important to chew your food.
By the time chyme reaches the colon most nutrients are absorbed. The chyme is stored in the out in the colon for 3-10 hours, and we rename it feces, which is made up of water, inorganic salts, epithelial cells, bacteria, products from bacterial decomposition, some undigested foods – hopefully not too much. The colon secretes mucus to help with movement, but it doesn’t excrete enzymes for digestion. It is bacteria that is responsible for decomposing any remaining carbohydrates and amino acids.
Bowel health – a broad look
American’s do not have great bowel health. It’s estimated that American spend over 725 million dollars annually on laxatives trying to regulate their bowels. Western pathologies of the colon include: constipation, irregular bowel movements, diarrhea, appendicitis, diverticulitis, Irritable Bowel Syndrome, colitis, Crohn’s Disease and colon cancer.
So what are healthy bowels like? It depends on a couple of factors – frequency, quantity and form. Welcome to what my students call the ‘perfect poop’ talk.
Frequency – How frequent a person should move their bowels depend on person and can vary vastly among ‘healthy’ people. One bowel movement a day is considered healthy the with two to three times a day not uncommon. Bowel movements every other day are considered not normal or healthy. Some people may go several days without a movement. Not moving the bowels frequently enough can lead to toxic accumulations and impacted bowels.
Transit time would also fall under frequency. This is the amount of time that it takes for the food you’ve ingested to pass through the entire digestive tract before exiting the body. One of the easiest ways to track this is to eat beets. You will notice a red tint to your bowels giving you transit time. The average transit time of the stools is about 1.5 days in rural Africa and 3 days in western countries. the medical definition of constipation is not have a bowel movement after three days or more. The term is often applied to unusually hard, sluggish, infrequent or dry stools.
Quantity – This is where we see significant differences in cultures. In rural Africa about 400-500g of stools are passed by an adult. In Western countries and adult passes about 80-120g of stools a day. That’s a big difference that is mostly due to the fact that western cultures eat fewer fiber rich foods.
Form – Form matters when it comes to stools. When it comes to healthy shape of stools they should be light-brown in color, roughly cylindrical in shape with creases (from the haustral churnning). They should not be overly smooth or ropey and they should mostly hold their form in toilet bowl. They should neither sink or float too high in the bowl, hanging out in the middle.
The Colon’s functions and sphere of influence in Asian medicine
We cannot speak about Colon without also discussing it’s Yin partner, The Lungs. The Lungs rule the descending and dispersing of Qi, Blood and fluids and the Colon needs to have adequate Qi to move the stools. If the Lung’s are weak or failing in this function the Colon may lack adequate Qi and Fluids to allow for defecation, meaning there will be constipation, stagnation and breathlessness. This Yin/Yang pair correspond to the Metal element, the season of Autumn and are often injured by dryness. This is also a relationship of top and bottom and though it seems odd at first a quick look at the two and you will see that “as above, so below” really fits. If the Lungs are dry, there is often constipation. If the Lungs, ruling the sinuses have phlegm the bowels are often loose and have mucus in them. As the topmost organ The Lungs take in air and transform it and give us inspiration, physically and mentally. The Colon as lowest organ on the body has the duty to release that which we no longer need. Let it go.
The channel runs from the index finger the posterior lateral aspect of the arm up to the ala (corner) of the nose. Many points along the channel are used for obstructions like headaches, neck and shoulder pain and constipation. If you’ve had an Amma session you’ve likely winced as we’ve held Colon 4 (Hégū) on the dorsum of the hand between the thumb and index finger. It’s a famous point for releasing headaches. We also use the points a lot to release exterior invasion like colds and flus when they invade Colon’s Yin partner the Lungs.
The Colon loathes dryness
When a dry climate prevails it is important to know how to offset their effects. Dry conditions in people usually are related to the Lungs or Liver Blood deficiency. This dryness is often caused by food imbalances (eating too many dried, refined foods), excessive physical activity, adverse climatic conditions (dry, hot climates) and organ malfunctions. Symptoms of dryness include: Thirst, dryness of throat, skin, nose, lips, itchiness, those who are chronically dry usually have a thin body type.
Colon corresponds to the pungent flavor
We use the pungent or spicy flavor to help break up stagnation and to move fluids and Qi. Pungent flavors run the spectrum from hot, spices like ginger and garlic to cool pungents like spearmint. We choose whether we need hot or cool based on the pathology we are treating. If you are hot and dry and have thirst, move to the cool category. If you are cold, soggy and damp move to the warmer spices. Happily resting in the middle the mild pungents like leeks, radish, turnips, delicate flavored onions and parsnips can be eaten by all. We also use the spicy flavor to open the pores and help you sweat out colds or adapt to hot climates – if appropriate. Those with Yin deficiency or lack of Fluids should not sweat out! Sorry, hot yoga is not ideal for many.
Read more about Autumn and Metal Element here.
Pathologies and disharmonies of the of the Colon (Large Intestines) according to Asian Medicine.
Rarely do Asian medicine practitioners just treat the Colon. Why? Because most of its functions rely on other health and functions of other organs.
Colon Qi deficiency – Breathlessness, mild constipation, difficulty with moving the bowel and fatigue, this is mostoften caused by Lung Qi deficiency.
Heat in Colon – common during or after flus, colds or being in extremely hot or dry climates. The fluids dry up making it hard to move the bowels and causing constipation and heat throughout the body. This can also be caused by eating too many hot and spicy and dry foods.
Damp heat in the Colon – explosive, foul smelling stools, possibly with pain. We often see this condition with excessive dietary habits of greasy fried foods, hot spices, excess dairy. It also often corresponds with damp heat in Gall Bladder conditions including chronic allergies and post viral syndromes, shingles and hives.
Cold in the Colon – Exterior cold can invade the Colon and cause painful cramping and diarrhea. You sat out at the football game on a cold bleacher and had diarrhea the next day.
Fluid deficiency in the Colon – The Colon relies on adequate Fluids from the Stomach to provide it with a moisture to move the bowels. The Stomach itself is easily affected by Stomach Yin and fluid deficiency which arises from eating too hurriedly, eating late at night or late in the evening, gulping your food, eating while emotional and eating too many dried, hot foods. Fluids dry up and there won’t be enough for the Colon to move the bowels and we see constipation. Other forms of extreme heat like fevers or being in hot climates can also cause this pattern. The tongue will often be red, dry and often have cracks especially in the center.
Spleen Yang deficiency – The Spleen rules all Transformation and Transportation in the body. It requires Yang (warmth, fire) to perform these functions and to adequately warm the Colon remove excess water from the stools. If Spleen Yang is deficient it can affect the bowels by causing loose stools and constipation patterns where the bowels aren’t dry but just difficult to move.
Liver Qi Stagnation – Liver Qi ensures the smooth flow of Qi. If the Qi stagnates it will knot the stools in the intestines and will cause small pellet like stools.
Kidneys – The Kidneys control the two lower openings and govern all Yin and Yang in the body. Kidney Yin deficiency will mean the body lacks fluids and the stools will be dry. Kidney Yang deficiency will mean the Colon will lack adequate heat to remove excess water from the bowels. For example – “Cock’s Crow” diarrhea refers to diarrhea that affects the person early in the morning (5 o’clock) with urgency and the bowels are explosive. Not a great way to start the morning.
Assessing the stools
Asian medicine practitioners should ask you a fair number of questions about your bowels including moisture, color, smell, pain or effort with defecation, frequency and shape. Here are a few examples of how we use the information.
- Stools that are small and round like pellets indicate Liver Qi stagnation or heat if they are very dry.
- Stools that are long and thin like a pencil indicate Spleen Qi deficiency.
- Dry stools indicate heat or Yin deficiency.
- Loose stools which are hesitant and difficult to come out indicate Spleen Qi deficiency with stagnation of Liver.
- Watery explosive stools, splashing in all directions indicate damp heat (yellow and frothy) or damp cold.
- Constipation with abdominal pain. Liver Qi or Cold. Cold is more severe and spastic. Liver qi usually accompanies abdominal distention.
- Bowel movement that require great effort or are exhausting indicate Qi or Yang deficiency.
- Cramps after defecation indication cold or stagnation.
- Pale stools indicate damp heat in Gall Bladder
- Dark stools indicate heat or blood in the stools.
- Green coloring in the toilet indicates bile and Gall Bladder patterns.
- Green stools in children indicates cold.
For your Colon’s sake
It’s wise to get in for an assessment if you have irregular or bowels issues to focus treatment and the following recommendations can help improve digestive and bowel health in anyone.
Avoid excess raw and cold foods – The Spleen rules digestion which requires Yang (warmth) to adequately transform foods. Excess consumption of cold and raw foods chills leads to Spleen Qi deficiency or Spleen Yang deficiency. The digestive fire starts to cool and the metabolism slows down. This leads to gas, bloating and loose stools and the tongue will be puffy or swollen.
Avoid excess consumption of hot and dry foods – Eating too many dried, baked, grilled, packaged foods or failing to hydrate with lead to Yin and Fluid deficiency in the Stomach, Small Intestines and the Colon. The Colon won’t have adequate fluids to move the bowels and the stools with will dry and hard. The tongue will be dry and often red.
Eat fiber – I’ll be honest, many traditional Asian medicine (Chinese medicine) texts do not list lack of fiber as problem. This is partly because they didn’t break down foods into parts like fiber, complex carbohydrates, etc. but mostly this is because their diets didn’t lack fiber which comes from vegetables. If you don’t eat vegetables, you are not getting fiber. Unfortunately, I see this with many fad diets greatly reduce or eliminate grains, lentils, legumes and vegetables. For short periods of time this can be okay, but be cautious too long without fiberous foods and your health will suffer. Studies show that increasing fiber can reduce your risk of colon cancer by up to 40%. Lack of fiber in the diet will cause the bowels to be sticky, heavy and dense and sink to the bottom of the stools. Find out more about fiber here.
Improve your eating habits- This is a broad category and includes eating under stress, overeating, eating to late at night or in the evening, hurriedly or having irregular meal times can all affect the Colon. Check out My Views On Nutrition for a list of good eating habits.
Avoid ingesting toxin – Medications, preservatives and recreational drugs all can have an impact on digestion and therefore the Colon health. Some lead to constipation and others can cause diarrhea.
Don’t avoid the urge – When the rectum fills and distends it sends a message to the brain that we recognize as the urge to defecate. If this urge is ignored there is build up, toxins and eventually flaccidity of the colon muscles due to chronic distention.
Manage stress and don’t overwork – Excitement, travel, anger, worry, anxiety, excessive mental and physical work can all affect the Colon and the bowels tighten up the bowls and block the Colon. Learn your patterns and habits so that you can put in place measures to deal with symptoms and start healing. Excessive physical work weakens the Spleen and injures the muscles. Spleen Qi deficiency fails to move the stools in the Colon and leads to constipation. The same situation may happen in women, post-childbirth if there is a pre-existing situation of Spleen Qi def. Working too long of hours without adequate rest for many years weakens the kidneys. If it weakens Kidney Yin it may cause constipation from dryness. If it weakens the Kidney yang it may cause constipation by leading to internal cold.
Exercise – Exercise stimulates perstalsis and a lack of exercise weakens the Spleen Qi and may also lead to Liver Qi stagnation. Deficient Spleen Qi over a long period of time fails to provide Qi to move the stools and may lead to constipation while stagnant Liver Qi may cause it by failing to move the Qi in the intestines.
Nourish fluids – The Colon is especially susceptible to dry conditions. Fluid deficiency can arise from hot, dry conditions, fevers, excess bleeding and sweating and simply failing to drink fluids.
Again, the health of the Colon relies on many other organs in Asian medicine and is very easily affected by our lifestyle habits. Learning your patterns and establishing healthy habits is the starting place for healing and creating better health.