## Loose, bound, or both
Few things shape a day as much as a gut you can't trust. Needing to know where every bathroom is. Bloating that builds through the afternoon. Days of nothing, then a rush. A stomach that reacts to stress before you've noticed you're stressed. These usually get called IBS, chronic constipation, or "a sensitive stomach," and the tests come back normal. Normal tests are good news. They just don't tell you what to do next.
The Donguibogam, the 1613 master text, gives the bowel its own chapter, one of the longest in the book. It sorts loose stools into more than a dozen kinds, separates them carefully from the bloody, urgent stools of more serious illness, and treats constipation as two different problems that need opposite treatment. We translated it in full.
[→ The Stool — full translated chapter]
## Diarrhoea is not dysentery
The chapter's first important line separates two things that can look alike. In ordinary loose stools, it says, the food may or may not be digested, but there is no straining — only a sense of lassitude. In what it calls dysentery, there is pus, or blood, or both, or mucus, with urgency and a heavy, dragging sensation afterwards that doesn't go away.
That is almost exactly the line modern medicine draws between IBS and inflammatory bowel disease. IBS can be miserable, but it doesn't cause bleeding, weight loss, or fever. Blood, pus, or mucus in the stool, urgency with a constant sense of not being finished, or waking at night to go — those need a proper medical workup first.
## The patterns patients recognize
The chapter lists many kinds of loose stool. A few describe the IBS picture so exactly that patients often recognize themselves at once.
**Bloated after eating, better as soon as you go.** The chapter calls this a Spleen pattern: a heavy body, a full feeling under the ribs after meals, a dull complexion, and relief the moment the bowel moves. It reads this as weak digestion, and treats it by strengthening rather than by stopping the bowel.
**Needing to go right after eating.** The chapter gives this its own short section: food goes down, and the bowel moves at once. It reads it as the digestion and the lower body not supporting each other.
**A loose stool every morning before dawn.** The chapter calls this the dawn diarrhoea, a Kidney pattern — one urgent, loose stool in the early hours, often with cold feet and a weak lower back. It is common in older patients, and it is treated by warming.
**Loose stools with rumbling and undigested food.** It reads cold in the bowel when there is rumbling and undigested food, and heat when the stool is yellow and burning. Pale, clear urine and cold hands point to cold; dark urine and warm hands to heat.
**Worse with stress.** The chapter describes loose stools that come when "wood overacts on earth" — the Liver pressing on the digestion. That is the IBS flare that follows a hard meeting, an argument, or a stressful week.
## Treat the middle first
The chapter's rule for loose stools is a sequence. First, strengthen the middle — the digestion itself. Second, help the body separate fluid from food. Only if those fail, hold the bowel back with astringent medicine. It warns against the shortcut of stopping the bowel too early, and against too much sweetness or too much bitterness: a bland, gentle approach works best.
## Two kinds of constipation
The chapter is clear that constipation is not one thing. It names two kinds and treats them in opposite directions.
**The full kind** — appetite is good, the urine is dark, the belly is full and hard. This is heat and dryness, and it is cleared.
**The empty kind** — appetite is poor, the urine is clear, the body is tired and the stool dry. This is depletion: not enough fluid and not enough push. It is moistened and nourished, not flushed.
It adds a warning that is still important. In older people, it says, strong purgatives like rhubarb must not be used: they draw out the remaining fluid, and the bowel binds again, worse than before. That is the cycle many people fall into with stimulant laxatives. The chapter's alternative is to moisten the bowel — with seeds, oils, and gentle formulas — and it recommends sesame and rich broths for older people with chronic constipation.
It also notes that the bowel moves partly with the breath: when the Lung's Qi doesn't descend, the stool is hard to move. That is one reason gentle movement and deep breathing help.
## What treatment looks like here
Acupuncture is used for IBS, constipation, and the stress that drives both. The chapter's points concentrate on the abdomen and the lower leg: ST25 Tianshu beside the navel and CV6 Qihai below it, CV4 Guanyuan, CV12 Zhongwan, ST36 Zusanli, ST37 Shangjuxu, and SP6 Sanyinjiao. For chronic loose stools it recommends moxibustion, including at GV20 Baihui at the crown — lifting what has sunk — and at the navel.
Herbal formulas follow the pattern. From the Stool chapter:
[Hyangsayukgunja-tang 香砂六君子湯] — for bloating after meals and relief after going
[Ijung-tang 理中湯] — for loose stools with cold in the middle
[Sasin-hwan 四神丸] — for the dawn diarrhoea
[Samchulgeonbi-hwan 參朮健脾丸] — for loose stools that have gone on a long time
[Bojungikgi-tang 補中益氣湯] — for chronic loose stools with fatigue
[Biyak-hwan 脾約丸] — for the full kind of constipation, with a good appetite and dark urine
[Yunjang-hwan 潤腸丸] — for dry, depleted constipation, especially in older patients
[Soma-juk 蘇麻粥] — a seed porridge the chapter recommends for constipation in the old
Between visits, a food-and-symptom diary for two weeks is one of the most useful things you can bring. Regular meal times, a warm breakfast, not rushing meals, and a short walk after eating help most people more than they expect.
Most people with IBS notice changes within several weeks. Long-standing constipation, especially after years of laxatives, takes longer to retrain.
If bloating and reflux are part of the picture, read more here — [Digestive health] · and for food reactions, [Food sensitivities]
## Inflammatory bowel disease
Crohn's disease and ulcerative colitis are serious immune conditions that need ongoing care from a gastroenterologist. The chapter's long section on dysentery — stools with blood and mucus, urgency, the dragging sensation, flares that settle and return — describes something close to what IBD patients live with, and it treats the relapsing kind as its own pattern.
We work alongside your gastroenterologist to help with symptoms between flares, fatigue, appetite, stress, and quality of life. We never ask you to stop or change prescribed medication.
## Please read this part
Some bowel symptoms need a physician first, and not later.
**Get emergency care if you have:** heavy rectal bleeding or black, tarry stools; severe abdominal pain, especially with a hard, swollen belly; vomiting with no bowel movement and no passing of gas; high fever with bloody diarrhoea; or signs of dehydration — dizziness, very little urine, confusion.
**Get evaluated before starting here if you have:** any blood or mucus in the stool; diarrhoea that wakes you at night; unexplained weight loss; a change in bowel habits after age 45, or that lasts more than a few weeks; a family history of colon cancer or IBD; iron-deficiency anaemia; or constipation that started suddenly with no clear reason.
The 1613 chapter has a long section of its own on fatal signs in diarrhoea and dysentery — passing pure blood, high fever with a racing pulse, cold limbs that won't warm, an inability to eat or drink. It also notes that children's diarrhoea can turn dangerous quickly. The instinct is the same today: some bowel symptoms are not to be waited on.
**This approach may help if you're dealing with:** IBS, with loose stools, constipation, or both · bloating and urgency after meals · loose stools in the early morning · constipation that depends on laxatives · constipation in older adults · bowel symptoms that flare with stress · symptoms between flares of Crohn's disease or ulcerative colitis, alongside your gastroenterologist's care.
The Donguibogam translation project at formulas.raahacupuncture.com is researched and translated by Eui Young (Justin) Chung, L.Ac., Dipl. O.M. — the same clinician you'll see in the treatment room.