What does my poop say about my health: Brehan Crawford, L.Ac., explaining why Chinese medicine asks about stool and dreams

What Does My Poop Say About My Health?

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    A first Chinese medicine appointment can feel nosy: an hour of questions about your bowels, your dreams, whether you sweat at night, and whether you want ice in your water. None of it is random. It is a formal system called the ten questions, and your answers say a great deal about you.

    The short answer

    A lot. The Bristol stool scale grades your poop from 1 to 7, and each number, read alongside your other symptoms, tells us how your gut is working. Your dreams matter just as much: constant fighting can point to a chronic infection, fleeing the fight to a body without the strength to mount an immune response, a flooded basement to excess water in your tissue. These are not diagnoses on their own. They are the clues that lead to one.

    The short version, on video.

    What does my poop say about my health?

    More than anyone has asked you about. If your doctor is not asking you about the quality of your poo or the images in your dreams, he or she may not be qualified to help fix your gut problems or your sleep difficulty.

    Before jumping into invasive tests that often do not lead to any kind of effective treatment, I think it is very important to ask about the symptoms people have and distill the pattern that is causing them. In a Danish trial of 302 patients with irritable bowel symptoms, a diagnosis built on symptoms and two simple blood tests was just as good after a year as a work-up with stool tests and sigmoidoscopy with biopsies, for quality of life, symptoms and satisfaction, and it cost less.[1]

    When 466 people with suspected non-constipation IBS had colonoscopies, structural problems in the colon were no more common than in 451 healthy people having routine screening.[2] The camera can show whether something structural is wrong. It cannot show why you feel the way you do. That is the gap the questions fill.

    Your bowel habit is also information few people are ever asked for. When researchers in Bristol recorded the bowel habits of nearly 1,900 adults, less than half had conventionally normal bowel function.[3] You may be living with a pattern you assume is normal. Reading that pattern is the starting point for everything I teach about digestive health, and it is daily work inside Gut Brain Synchrony.

    Bristol stool chart: what is normal?

    The Bristol stool scale grades your stool from a one to a seven. Types 1 and 2 are hard: separate lumps, or a lumpy sausage. Types 3 to 5 are the normal range: a sausage with cracks, a smooth soft snake, soft blobs with clear edges. Types 6 and 7 are loose: mushy pieces, then liquid. Each of those numbers, in the context of your other symptoms, can tell us a lot about your gut function.

    The scale is more than a picture chart. When Lewis and Heaton measured whole-gut transit time in 66 volunteers, stool form tracked it better than how often people went, and when transit was sped up or slowed with medication, the stool score moved with it.[4] A King’s College London study found that people’s ratings of their own stool matched its measured water content and separated healthy volunteers from people with diarrhea-predominant IBS.[5] In 53 healthy women, Bristol stool consistency correlated with every major marker of the gut microbiome, including species richness.[6]

    Chinese medicine stool diagnosis

    Chinese medicine reads the same stool for the pattern behind it, and never alone.

    01 Hard, dry, pellets (types 1 and 2). Heat drying the fluids, or blood and yin too thin to moisten the bowel. Rabbit-dropping pellets often go with stagnation and stress.
    02 Formed and easy (types 3 to 5). Digestion is transforming food and fluids well, and the other questions decide what is happening elsewhere.
    03 Loose (types 6 and 7). The Spleen, which transforms food and fluids, is not keeping up, and dampness runs through. Undigested food points toward cold; sticky, foul, burning stool toward damp-heat.

    What do dreams tell you about your health?

    Your dream imagery is equally as important. The Huangdi Neijing, the classic of internal medicine, gives a chapter of its Lingshu to how imbalances show up in sleep, and sorts those dreams into dreams of excess, which call for draining, and dreams of deficiency, which call for building up.

    Modern research is arriving at a similar picture. Immune signalling molecules such as interleukin 1 act on the brain’s sleep systems, and during infection those interactions are amplified and the structure of sleep changes.[7] The dream researcher Patrick McNamara proposes that when something in the body is going wrong, the brain’s updated picture of the body shows up in REM dreams, in picture language or metaphor, where it can be interpreted to help diagnose illness that is still emerging.[8]

    The gut has its own line in. In a survey of 396 students, 17.8 percent had noticed particular foods producing bizarre or disturbing dreams, dairy most often, and those people reported more disturbing dreams and poorer sleep.[9] Gut problems and sleep difficulty travel together, which is why I ask about both.

    Why do I dream about fighting?

    If you are constantly dreaming of getting into fights or of violent encounters, you may have a chronic infection. In the Neijing’s terms this is a dream of excess: when yin and yang are both exuberant, one dreams of fighting and killing. Two strong forces are locked in battle, which is exactly what a body holding off a lingering pathogen is doing.

    Illness changes what we dream. Fever dreams are more bizarre and more negatively toned than ordinary dreams.[10] In a survey of 9,328 adults across 16 countries, 23.0 percent reported frequent nightmares during a COVID-19 infection, against 8.1 percent of those not infected, and 18.0 percent of people with long COVID did, against 8.5 percent.[11]

    Fleeing the fight

    If you are fleeing those types of conflict in your dreams, your body may not have the strength to mount an immune response to one. This is the deficiency side of the same picture: the conflict is there, but the defensive wei qi is too weak to meet it. Imeri and Opp argue that the changes in sleep during infection are tailored to support fever, the body’s own counterattack.[7] A body that keeps running in its dreams is one that cannot muster that counterattack, and the treatment is to build it up.

    Dreaming of a flooded basement

    If you dream of a flooded basement, you could be carrying excess water in your tissue. The Neijing says it plainly: when yin is abundant, you dream of wading through great water, and you are afraid. The basement is the lowest part of the house, where damp collects, so the dream is worth checking against swelling, heaviness and, again, the stool.

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    What is pattern diagnosis in Chinese medicine?

    These things alone are not medical diagnoses, but they are the clues that can often lead to one. Pattern diagnosis is how the clues are put together, because two people can walk into the clinic with the exact same symptoms and need completely different approaches.

    Syndrome differentiation, bian zheng, is the analysis of everything gathered by looking, listening, questioning and feeling the pulse, used to choose the treatment, and it further sorts people who share the same conventional diagnosis.[12]

    Those groups are measurable. In people with diarrhea-predominant IBS, those with the Liver depression and Spleen deficiency pattern overexcreted bile acids more often, 41 percent against 23 percent of other patients, carried a distinct mix of bile-acid-transforming bacteria, and had more severe bowel symptoms that tracked with them.[13] Same label, different biology underneath.

    The pattern shapes the outcome too. In a JAMA trial of 116 people with IBS, Chinese herbal medicine beat placebo, and fourteen weeks after treatment ended, only the group whose formulas were tailored to each person still held their improvement.[14]

    That is why you don’t just suppress the symptoms in effective treatment. You look at the whole picture so you can treat the cause of someone’s illness.

    What are the ten questions in Chinese medicine?

    The ten questions are the formal interview of Chinese medicine. The best-known version is a rhyme by the Ming dynasty physician Zhang Jingyue: cold and heat, sweating, head and body, stool and urine, food and drink, the chest, hearing, thirst, past illness, and the cause. Sleep and dreams belong to the interview too. That is why a first appointment can spend an hour on your bowels, your dreams, your night sweats and the ice in your water.

    The reason is that the same symptom can be treated differently depending on the pattern underneath it. Two people with the same headache can leave with two different prescriptions. Here are three of the ten questions to ask yourself.

    01 Do you run hot or cold? It comes first in the rhyme for a reason. A 20-item cold-heat questionnaire, checked against TCM doctors’ diagnoses in two groups of hospital patients, sorted people into cold or heat patterns with 94.9 and 92.3 percent accuracy.[15]
    02 Do you want your drinks with ice or without? A craving for ice leans toward heat; wanting everything warm leans toward cold. Ice also acts on the stomach: a drink at 4°C (39°F) dropped the temperature inside the stomach to about 21°C (70°F) within 45 seconds and at first left it more slowly than a drink at body temperature.[16]
    03 Do you wake at a set time? Chinese medicine’s body clock gives each organ a two-hour window. Waking at the same hour night after night points to that organ, the classic example being the Liver’s hours of 1 to 3 a.m.

    Night sweats belong to the second question. They are a hallmark of yin deficiency, and a Yin Deficiency Scale built from signs such as night sweats and dry mouth matched clinicians’ diagnoses with 73.7 percent sensitivity and 84.8 percent specificity.[17]

    Your answers already tell you something about yourself, and there are seven more questions where those came from. If sleep is where your clues point, For Patients Who Cannot Sleep is a good next read.

    How to start reading your own pattern

    01 Check your stool against the chart. Note the number more than once. One stool is a snapshot; the pattern is what counts.
    02 Notice your dreams. Write down the images that keep coming back: fights, running, water.
    03 Answer the three questions. Hot or cold? Ice or no ice? Do you wake at a set time? Add night sweats if you have them.
    04 Read the clues together. Loose stools, warm drinks and dreams of water tell one story; hard stools, thirst and fighting tell another.

    Poop, dreams and Chinese medicine: your questions

    Can an acupuncturist diagnose?

    An acupuncturist trained in Chinese medicine makes a pattern diagnosis from exactly these clues. They are not medical diagnoses on their own, but they can often lead to one.

    Can dreams predict illness?

    Chinese medicine has read them that way since the Neijing. A dream that keeps repeating is worth writing down.

    What do vivid dreams mean in Chinese medicine?

    Constant, vivid dreaming is usually read as the Heart and Liver not settling at night, often because blood or yin is too thin to anchor the mind. What you dream about points to where the imbalance sits.

    So if your practitioner asks about your poop, now you know why.

    — Brehan Crawford, L.Ac.

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    Your everyday clues are a map. Learn to read it.

    If you have gut problems or trouble sleeping and nobody has asked about your stool or your dreams, come learn how to connect the clues. I break it all down inside Gut Brain Synchrony and help people there every day, with courses, condition-specific programs and weekly live Q&A.

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    References

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    2. Chey WD, Nojkov B, Rubenstein JH, Dobhan RR, Greenson JK, Cash BD. The yield of colonoscopy in patients with non-constipated irritable bowel syndrome: results from a prospective, controlled US trial. Am J Gastroenterol. 2010;105(4):859-865. doi:10.1038/ajg.2010.55
    3. Heaton KW, Radvan J, Cripps H, Mountford RA, Braddon FE, Hughes AO. Defecation frequency and timing, and stool form in the general population: a prospective study. Gut. 1992;33(6):818-824. doi:10.1136/gut.33.6.818
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    5. Blake MR, Raker JM, Whelan K. Validity and reliability of the Bristol Stool Form Scale in healthy adults and patients with diarrhoea-predominant irritable bowel syndrome. Aliment Pharmacol Ther. 2016;44(7):693-703. doi:10.1111/apt.13746
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