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RECTAL PROLAPSE

GENERAL

Clinical Manifestations	Rectal prolapse often used to mean complete rectal prolapse (external rectal prolapse), where the rectal walls have prolapsed to a degree where they protrude out the anus and are visible outside the body. However, most researchers agree that there are 3 to 5 different types of rectal prolapse, depending on if the prolapsed section is visible externally, and if the full or only partial thickness of the rectal wall is involved. Rectal prolapse may occur without any symptoms, but depending upon the nature of the prolapse there may be mucous discharge (mucus coming from the anus), rectal bleeding, degrees of fecal incontinence and obstructed defecation symptoms. Rectal prolapse is generally more common in elderly women, although it may occur at any age and in both sexes. It is very rarely life-threatening, but the symptoms can be debilitating if left untreated.
Treatment Principle
Herb Formulas	Topical: Zi Yun Gao
Points	DU-1, DU-20, REN-6, ST-25, UB-57 With bleeding: + moxa or moxa needle DU-4 With spasms and pain: + UB-30 DU-1, DU-20, REN-6, SP-6, ST-36 moxa REN-8 DU-1, DU-4, DU-20, GB-34 DU-1, DU-4, DU-20, PC-6, SJ-3, SJ-7, SP-4, SP-12, SP-15, ST-25, UB-31, UB-32, UB-33, UB-34, UB-35, UB-57, UB-58, UB-62 LIV-2, ST-25, ST-36, UB-22, UB-23, UB 24, UB-25, UB-26 DU-1, DU-20, GB-21, LI-4, ST-30, UB-25 DU-1, UB-5, UB-30, UB-35 With Lung involvement: DU-1, REN-17, ST-25, ST-36, UB-13, UB 24, UB-25, moxa REN-8 Moxa: 1. 7 cone on the xiphoid process 2. 3 cones on DU-1, DU-20, UB-21 3. For Cold: 100 cones on REN-9 Ear: Lower Rectum, Subcortex

LUNG QI AND YIN DEFICIENCY

Clinical Manifestations	Rectal prolapse Chronic cough or Dry cough Insomnia Night sweats Spontaneous perspiration Weakness Palpitations Shortness of breath Fever Irritability T: Red and dry or Red and swollen C: Little or None P: Thready and weak
Treatment Principle	Replenish Qi and Yin Generate Body Fluids
Herb Formulas	Sheng Mai Yin Wan
Points

LARGE INTESTINE DEFICIENCY WITH SLIPPERY PROLAPSE

Clinical Manifestations	Chronic dysentery or Chronic diarrhea or Rectal prolapse Dull abdominal pain with liking for warmth and pressure Borborygmus Cold limbs Poor appetite Mental fatigue T: Pale C: White P: Minute, thready and forceless
Treatment Principle	Benefit the Intestines Consolidate and astringe
Herb Formulas	Zhen Ren Yang Zang Tang Bu Zhong Yi Qi Tang
Points	DU-1, DU-20, UB-25 DU-1, DU-20, UB-30, UB-57

SPLEEN QI DEFICIENCY WITH QI AND FOOD STAGNATION

Clinical Manifestations	Rectal prolapse Loss of appetite Chest, epigastric and abdominal focal distention Acid regurgitation T: Normal C: White or Yellow and greasy P: Deficient or Slippery
Treatment Principle	Tonify the Spleen Reduce focal distention
Herb Formulas	Zhi Zhu Wan
Points

CENTRAL QI SINKING

Clinical Manifestations	Rectal mucosa everts on exertion Little pain Prolapse of the rectum, especially after defecation Rectum does not retract Pale face Dyspnea Sallow complexion Anorexia Four limbs feel tired and heavy Abdominal and epigastric distention after eating Maybe acid regurgitation or vomiting Loose stools Shortness of breath T: Pale and flabby - may have teethmarks C: White P: Even or Soft and thready or Deep and weak
Treatment Principle	Strengthen the Spleen Benefit Qi Reinforce the Center Invigorate Yang
Herb Formulas	Bu Zhong Yi Qi Tang Huang Qi Jian Zhong Tang Ju Yuan Jian
Points	DU-20, local points DU-1, DU-20, UB-30, UB-57

SPLEEN AND STOMACH DEFICIENCY COLD

Clinical Manifestations	Constant diarrhea Rectal prolapse after diarrhea Does not retract Mild constant epigastric pain; relieved by warmth and pressure Anorexia Abdominal pain and fullness after meals Nausea Vomiting Loose, unformed stools Excessive salivation Cold limbs Lassitude Weakness Sallow or pale, dull complexion Maybe edema Maybe scanty urination Maybe clear, watery, copious vaginal discharge T: Pale C: White and greasy P: Deep, thready and forceless
Treatment Principle	Strengthen the Spleen Warm Yang Warm the Center Dispel Cold
Herb Formulas	Fu Zi Li Zhong Wan Xiao Jian Zhong Tang Gan Jiang Ren Shen Ban Xia Wan Wei Feng Tang
Points	Moxa or moxa needle DU-1, DU-20, REN-8, SP-6, ST-36, UB-20, UB-21, UB-25 Moxa or moxa needle LIV-13, REN-12, SP-3, SP-6, ST-36, UB-20, UB-21

SPLEEN AND KIDNEY YANG DEFICIENCY

Clinical Manifestations	Body cold Limbs icy Complexion white and shiny Low back, knees and abdomen feel cold and painful Lower abdomen feels cold and painful Loose stools containing undigested food “Cock-crow” diarrhea (occurs at about 5 am) Edema of face and limbs Dysuria Severe: Abdominal ascites T: Pale, moist and swollen C: Thin and white or White and greasy P: Deep, thready, weak and maybe slow
Treatment Principle	Warm and Reinforce the Spleen and Kidneys
Herb Formulas	Ba Wei Di Huang Wan
Points	Moxa or moxa needle REN-4, REN-12, SP-6, SP-9, ST-36, UB-20, UB-23

LIVER YIN DEFICIENCY WITH LIVER QI STAGNATION AND EXTERNAL INVASION

Clinical Manifestations	Rectal prolapse Fever and chills Headache Thirst Sore throat Abdominal pain due to disharmony between the Liver and Stomach Epigastric, hypochondriac or flank pain Muscle spasms, pain and numbness Chronic dysenteric disorders Uterine prolapse Vertigo Dizziness Thoracic and costal pain, Menstrual irregularity Five Sole Heat T: Red C: Little or None P: Thready, wiry and rapid and maybe floating
Treatment Principle	Release the Exterior Clear Heat Relieve toxicity Raise Yang and lift Sunken Qi Spread Liver Qi Relieve Stagnation Nourish the Blood
Herb Formulas	Huo Yu Tang
Points

KIDNEY YANG DEFICIENCY

Clinical Manifestations	Lumbago: low back feels cold, weak and aching Feeling chilled Aversion to Cold Cold limbs General debility Pale face Urinary frequency with abundant, clear urine or Oliguria with edema Maybe nocturia Lassitude Withdrawn, subdued behavior Knees feel cold and aching Dizziness Tinnitus Impotence Spermatorrhea Premature ejaculation Low libido Female infertility ("uterus cold and infertile") Maybe anorexia Maybe loose stools Maybe chronic diarrhea or "cock crow" diarrhea T: Pale and swollen C: Thin and white P: Deep and thready - maybe slow
Treatment Principle	Warm and Reinforce Kidney Yang
Herb Formulas	Jin Gui Shen Qi Wan
Points	Moxa or moxa needle DU-4, KI-3, REN-4, UB-23 For chronic diarrhea, rectal prolapse and Vanquished Yang: + moxa DU-20, REN-8 For Kidney Yang Deficiency impotence: moxa or moxa needle DU-4, DU-20, KI-3, REN-4, UB-23 For Kidney Yang Deficiency (Cock Crow) Diarrhea: moxa or moxa needle DU-20, KI-3, REN-4, UB-23

QI, BLOOD AND YANG DEFICIENCY

Clinical Manifestations	Anemia Uterine bleeding Cold extremities Pale or sallow face Dizziness General fatigue Coarse skin Nocturnal emissions Weak knees Fatigue Dyspnea Night sweats Irregular menstruation Insomnia Intolerance of Cold Decreased eyesight after a prolonged illness Anxiety Intermittent fever Jaundice Deficient cough Shortness of breath Palpitations Anorexia Listlessness Lassitude Spontaneous sweating Spermatorrhea Continuous spotting Leukorrhea Weak legs and knees T: Pale C: Thin and white P: Thready and weak
Treatment Principle	Replenish Yang Warm and tonify Qi and Blood
Herb Formulas	Shi Quan Ba Bu Tang
Points

BLOOD DEFICIENCY

Clinical Manifestations	Rectal prolapse Postpartum emaciation and weakness Persistent, tight abdominal pain Abdominal pain with spasms or radiates to back and waist Cannot eat Shortness of breath Dyspnea Pale face Intermittent spasmodic abdominal pain which is better with Heat and pressure Epigastric pain Lusterless complexion Fidgeting Reduced appetite Maybe low-grade fever Palpitations Irritability Cold and sore extremities Nonspecific discomfort Dry mouth and throat Nocturnal emission Five Sole Heat Debilitated constitution in children Enuresis in children Insomnia Fatigue Anemia Bleeding Abdominal weakness Epistaxis Habitual constipation Maybe warm extremities Night sweats Tired limbs Frequent urination Night crying Diarrhea in children Habitual headache in children Hernia pain in children Chronic constipation Purpura Asthma T: Pale C: White P: Weak and slow or Thready, wiry and even or Thready and weak
Treatment Principle	Warm and tonify the Spleen and Stomach Nourish the Blood
Herb Formulas	Dang Gui Jian Zhong Tang
Points

DAMP-HEAT

Clinical Manifestations	Rectal mucosa everts on exertion The rectal mucosa appears dark purple or deep red, feels firm, and may be eroded or ulcerated Rectal prolapse with a distended feeling Tenesmus and/or a burning sensation in the anus Maybe bleeding Violent pain like needle pricks Red complexion Fever or Afternoon fever Thirst Halitosis Fullness and discomfort of the chest and abdomen Hypochondriac pain Headache Dizziness Red sore eyes Hearing loss Swelling in the ears Bitter taste in the mouth Irritability Short temper Difficult and painful urination with a heat sensation in the urethra Swollen and itchy genitalia Yellow, foul smelling leukorrhea Short menstrual cycle with reddish-purple blood Ear discharge Yellow urine Chest pain Dry stools Constipation or Incomplete bowel movements or Chronic diarrhea or Dysentery Turbid urine Dry mouth and throat Hematuria Dysuria Pain in the armpits Sweating in the groin T: Red or Red edges C: Yellow or Yellow and greasy P: Wiry, Excess and rapid or Deep and slippery
Treatment Principle	Clear and Drain Damp-Heat from the Lower Jiao
Herb Formulas	Long Dan Xie Gan Tang Yi Zi Tang Liang Ge Qing Chang San With Exterior symptoms: Ge Gen Huang Qin Huang Lian Tang In the Stomach and Intestines: Huai Hua San Topical: Decoct Rx. Boehmeriae Zhu Ma Gen and wash the rectal area. Chinese Patent Medicines: Huang Lian Jie Du Wan With a tendency toward sluggish stools or constipation: Yi Zi Tang For bleeding hemorrhoids: Zhong Guo Zhi Gen Duan With severe Heat: Chuan Xin Lian Kang Yan Pian
Points	DU-1, DU-20, UB-24, UB-25, UB-33, UB-36, UB-57 DU-1, DU-20, UB-25, SP-6, ST-28, ST-36 DU-1, DU-20, LI-11, SP-9, ST-37, UB-25, UB-30, UB-31, UB-32, UB-33, UB-34, UB-57 With swelling and pain: + UB-54, UB-58 With Liver Heat: + LIV-2 Magnets: DU-2 Ear: Large Intestine, Spleen, Prolapse, Hemorrhoids, Shenmen

HEAT AND BLOOD STAGNATION

Clinical Manifestations	Lower abdominal distention and pain (usually on right) Pain increases on pressure with rebound tenderness Guarding of the abdominal musculature Groin pain resembling urinary dysfunction without urinary difficulty Groin pain relieved by flexing hip and knee Groin pain intensified by extending hip Perspiration Irregular or intermittent fever followed by chills and perspiration May be mass in lower right quadrant of abdomen Aversion to Cold Hard lumps T: Pink C: Thin, white or yellow and greasy P: Slippery and rapid or Tight or Wiry and tight or Tight and rapid
Treatment Principle	Drain Heat Break up Blood Stasis Invigorate the Blood Reduce swelling
Herb Formulas	Da Huang Mu Dan Pi Tang
Points