bubble_chart Concept

The inability to control bowel movements, with involuntary slipping or complete loss of control, even to the point of being unaware of defecation, is referred to as fecal incontinence.

In ancient medical texts, there is no dedicated discussion on fecal incontinence, which is sometimes referred to as "efflux diarrhea"; or "fecal incontinence"; or "fecal incontinence," all of which refer to the condition of fecal incontinence. If there is frequent defecation but the individual can still control it, or if fecal incontinence occurs after anal surgery, these cases are not within the scope of this discussion.

bubble_chart Pattern Analysis

1. Exuberance of Heat Toxin︰It is commonly seen in patients with epidemic toxic dysentery, characterized by sudden onset, purplish-red purulent bloody stool or bloody watery stool, high fever, dysphoria, thirst, or even convulsive syncope and unconsciousness, involuntary defecation, a red tongue with yellow coating, and a surging-rapid or slippery-rapid pulse. It often occurs during high fever and unconsciousness in epidemic toxic dysentery. The pestilential pathogen is violent in nature and harms people rapidly. Dampness-heat toxic pestilence accumulates in the intestines, leading to internal collapse of healthy qi, failure of healthy qi to overcome the pathogen, inward invasion of heat toxin into the heart-nutrient level, orifice blockage and unconsciousness, and involuntary defecation. For its clinical features, refer to the entry on purulent bloody stool. Treatment should focus on clearing heat and removing toxin, cooling the nutrient level and opening orifices. The recommended formula is Coptis Detoxification Decoction combined with Pulsatilla Decoction with modifications. For orifice blockage and unconsciousness, add Peaceful Palace Bovine Bezoar Pill or Supreme Treasured Pill.
2. Spleen-kidney Yang Deficiency︰Chronic dysentery with prolonged duration, frequent bowel movements, fecal incontinence, constant discharge of mucous stools, aversion to cold and cold intolerance, cold limbs, poor appetite, abdominal distension and fullness, soreness of the waist, tinnitus, clear and profuse urine, pale and swollen tongue with white or slippery coating, deep and thin pulse. $spleen-kidney yang deficiency fecal incontinence and qi deficiency sinking fecal incontinence! Both are deficiency patterns, with a slow onset and prolonged course, but the disease cause and mechanism of disease differ—one is due to the decline of yang qi, the other to the sinking of middle qi. Spleen-kidney yang deficiency is often seen in patients with chronic diarrhea or prolonged diarrhea before dawn, which injures the spleen and kidneys. Spleen yang fails to rise, leading to deficiency-cold in the middle burner and impaired transportation and transformation; kidney yang is deficient, the life gate fire declines, unable to decompose food and transform it into essence, resulting in unceasing chronic diarrhea, incontinence, diarrhea with undigested food, reversal cold of limbs, and other obvious symptoms of spleen-kidney yang deficiency. Treatment should focus on warming and tonifying the spleen and kidney, supplemented with relieving collapse with astringent therapy. The prescription used is Liuzhu Yin (Six-Pillar Decoction) with Cassia Bark, Dried Ginger, and red halloysite. Sinking of middle qi is commonly seen in the elderly or those with weak constitutions and prolonged illness, where spleen qi gradually declines, qi deficiency leads to sinking, and inability to retain, resulting in fecal incontinence. Treatment should aim at tonifying the middle and replenishing qi, lifting and securing prolapse. The prescription used is Immortal Organ-Nourishing Decoction with Astragalus Root and Dried Ginger.
3. Qi Sinking︰Stool continuously leaks out unknowingly, even with prolapse of the rectum that fails to retract. The body is emaciated, the spirit is listless, appetite is sluggish, and there is epigastric fullness after eating, accompanied by palpitations, shortness of breath, reluctance to speak, faint and low voice, pale complexion, a pale and swollen tongue with tooth marks on the edges, and a deep, thin, and weak pulse. Incontinence due to spleen-kidney yang deficiency and incontinence due to qi deficiency and sinking are both deficiency patterns, with a slow onset and prolonged course, but their disease mechanisms differ. One is due to the decline of yang qi, while the other is due to the sinking of middle qi. In cases of spleen-kidney yang deficiency, it is often seen in patients with chronic diarrhea or prolonged early morning diarrhea, which damages the spleen and kidneys. Spleen yang is weak, leading to deficiency-cold in the middle burner and impaired transportation and transformation. Kidney yang is deficient, the life gate fire is weak, and it fails to decompose food and transform essence, resulting in persistent chronic diarrhea, uncontrollable leakage, undigested food in the stool, and cold limbs—all clear signs of spleen-kidney yang deficiency. Treatment focuses on warming and tonifying the spleen and kidneys, supplemented with astringent therapy to relieve collapse. The formula used is Six Pillars Decoction with the addition of Cassia Bark, Dried Ginger, and red halloysite. In cases of sinking middle qi, it is commonly seen in the elderly or those with prolonged illness and weak constitution. Spleen qi gradually declines, qi deficiency leads to sinking, and the inability to retain stool results in incontinence. Treatment should focus on tonifying the middle and replenishing qi, lifting and securing prolapse. The formula used is Immortal Organ-Nourishing Decoction with the addition of Astragalus Root and Dried Ginger.

Excessive heat toxin causing fecal incontinence is an interior excess heat pattern, while sinking of middle qi and spleen-kidney yang deficiency causing fecal incontinence is an interior deficiency pattern. Those with yang deficiency also exhibit cold signs, while those with qi deficiency do not yet show cold signs. However, if qi deficiency is left untreated, it can develop into spleen-kidney yang deficiency.

bubble_chart Documentation

1. Shengji Zonglu: "The large intestine serves as the officer in charge of transportation, managing the transformation of waste, with the anus as its indicator. If the organ is cold and qi deficient, it cannot contract properly, leading to uncontrolled transformation of waste, hence fecal incontinence occurs irregularly."