Constipation

WESTERN MEDICINE: Constipation is a symptom of difficult or infrequent passage of feces. This symptom is common to many functional and organic disorders. Organic causes include mechanical or paralytic obstruction of the intestine, neoplasm, diverticulitis, and inflammatory stenosis. The common functional causes of chronic constipation are those which hamper normal bowel movements because the storage, transporting, and evacuating mechanisms of the colon are deranged, sometimes by systemic disorders (e.g., debilitating infections; thyroid, parathyroid, or adrenal malfunction) but more often by local neurogenic disorders (e.g., initable colon, inactive colon, and megacolon).

SYMPTOMS AND SIGNS: Constipation is a symptom of the difficult passage of feces, or prolonged defecating time, or difficult passage of feces even with strong desire of defecating, and feces are not of the hard type. Chronic constipation usually will show other symptoms, such as abdominal fullness or pain, dizziness, extended feeling of head, poor appetite, insomnia, listlessness, and etc. 

ETIOLOGY AND PATHOLOGY: In the book of Shanq Han Lun (Treatise on Febrile Diseases), constipation is called Yang Jie (Yang constipation), Ym Jie (Yin constipation), Pi Yue (Constipation due to spleen problem). Later, constipation has been called many names according to their etiologic and pathological factors, such as Feng Mi (constipation due to wind), Re Mi (constipation due to heat), Xu Mi (constipation due to deficiency), Qi Mi (constipation due to stagnant Qi), Shi Mi (constipation due to excess), etc.Constipation is caused by the dysfunction of spleen, stomach and large intestine due to the many following reasons:

  1. The internal heat stagnated in the intestines and stomach due to the Yang excess body type, or excessive alcoholic drinks, or eating too much spicy and hot food. The stagnated heat consumes the body fluids of the intestines which result in constipation.
  2. Depression or other prolonged emotions cause the stagnation of Qi which leads to the disorder of the intestines and stomach, hence causing constipation.
  3. The deficiency of Qi and blood due to chronic stages of other diseases, or weak body type, or elderly will cause the insufficiency of body fluids, later causing constipation.
  4. The stagnation of Yin coldness due to the Yang deficiency, or old age obstruct the intestines, body fluids can not be transported and distributed to the intestines so causing constipation. 

DIFFERENTIATIONS: 

1. Constipations of Excessive Types:

(1). Constipation due to the Internal Heat: 

Indications: Difficult defecating, dry and hard feces, scanty, hot and yellowish urine, flushed complexion, hot or fever sensation of body, or accompanied with fullness and pain of abdomen, thirsty, foul breath, restlessness, red tongue, yellow coating, or yellow and dry coating, slippery and rapid pulse. 

Treatment & Formulas: Clear the internal heat and moisten the intestines.

Products:

    • Ma Zi Ren Wan (Apricot Seed and Unum Formula Item No. 2175): This is a typical formula to treat constipation due to internal heat and the insufficiency of body fluids of intestines. It is often used for habitual constipation, hemorrhoids, constipation in the elderly and weak. 
    • Xaio Cheng Qi Tang (Minor Rhubarb Combination Item No. 2028): It is a strong cold purgative formula for internal heat in stomach and intestines. It is used for constipation with strong internal heat. It is more often applied for acute simple intestinal obstruction, acute cholecystitis, acute appendicitis, and some other diseases with strong heat symptoms. 
    • Tao He Cheng Qi Tang (Persica and Rhubarb Combination, Item No. 2165): This is a cold purgative like Xiao Cheng Qi Tang above, plus it has the function of eliminating the blood stasis by its promotion of blood circulation. It is used for a person with heat and blood stasis in the lower burner. The symptoms show constipation, acute abdominal pain, neurotic, delirium, thirsty, hard stool, no urination, fever at night. It is often applied to menstrual irregularity, oliguria due to internal injury, menopausal disorders, neuralgia, freckles, eczema, all are due to the internal heat and blood stasis at lower burner. 
    • Da Huang Mu Dan Pi Tang (Rhubarb and Moutan Combination, Item No. 2040): This is a purgative formula for blood stasis in lower abdomen.It eliminates the stagnant heat in the intestines, and regulates blood by promoting the blood circulation. It is often applied to intestinal abscess, acute appendicitis, pelvic inflammation, uterine myoma, difficult menstruation, ovaritis, pyelitis due to stagnant blood in the lower abdomen. 
    • Fang Feng Tong Sheng San (Siler and Platycodon Formula, Item No. 2103): This is a formula to eliminate both interior and exterior intense heat due to the effect of wind and heat. It is very effective for weight loss of obesity with strong constipation. It is also applied for cardiac diseases, arteriosclerosis, hypertension, stroke, nephritis, baldness, autotoxicity, ear or nose infection, diabetes, dermatoses, hemorrhoids, sciatica, shoulder stiffness due to the interior and exterior heat. 

(2). Constipation due to the stagnant Qi:

Indications: Difficulty defecating even with strong desire to, frequent belching, fullness or pain in abdominal and hypochondriac areas, poor appetite, thin and greasy tongue coating, wiry pulse.

Treatment & Formulas: Regulate the stagnated Qi and promote the circulation of Qi in intestines.

Products:

    • Xiao Yao San (Tang - Kuei and Bupleurum Formula, Item No. 2195): This regulates the stagnant Qi and harmonizes the spleen and stomach. It can be combined with Ma Zi Ren Wan (Apricot Seed and Unum Formula, Item No. 2175) to clear the intestine heat and  moisten the body fluids, or combined with Xiao Cheng Qi Tang (Minor Rhubarb Combination, Item No. 2018) to treat constipation with strong internal stomach and intestine heat. 

2. Constipations of Deficiency Type:

(1). Constipation due to the Qi Deficiency:

Indications: Difficult to pass the feces even when the stool is not dry or hard, hard to defecate, sweating and shortness of breath while or after trying to pass the feces, pale complexion, lassitude, listlessness, weak limbs, pale tongue, white coating, weak pulse.

Treatment and Formulas: Strengthen the middle Qi by promoting the function of spleen and stomach so as to relieve the constipation. 

Products:

    • Bu Zhong Yi Qi Tang (Ginseng and Astragalus Combination, Item No. 2225): Tonifies the middle Qi and promotes the function of spleen and stomach. It is very effective for constipation due to the Qi deficiency.

(2). Constipation due to the Blood Deficiency:

Indications: Constipation, lusterless complexion, dizziness, blurry vision, palpitation, pale lips and tongue, thready pulse. 

Treatment & Formulas: Tonify blood and moisten intestines. 

Products:

    • Si Wu Tang (Tang - kuei Four Combination, Item No. 2060): This is a tonic formula for blood, so it can treat constipation due to blood deficiency, it can be combined with Ma Zi Ren Wan (Apricot Seed and Unum Formula, Item No. 2175) for better results. 

(3). Constipation due to the Yang Deficiency:

Indications: Difficulty passing feces, profuse urination, pale complexion, cold limbs and body, prefers warm sensation, cold and pain at abdomen, or sore and cold sensation of lumbar and spine regions, pale tongue, white coating, deep and slow pulse.

Treatment & Formulas: Tonify the Yang so as to ease the stool passage. 

Products:

    • Ba Wei Di Huang Wan (Rehmannia Eight Formula, Item No. 2011): It tonifies both kidney Yang and Yin thereby relieving constipation.
    • Jia Wei Chang Chung (Ginseng & Condonopsis Combination, Item No. D3041, S3101): It is a tonic for kidney. 
    • The above two formulas can be combined with Ma Zi Ren Wan (Apricot Seed and Unum Formula, Item No. 2175) to achieve better results for constipation.

Comments: Constipation due to the heat of the stomach and intestines, Da Huang granule (Rheum Rhizoma, Item No. 1013) can be used as a daily drink. Constipation due to Yin deficiency or the elderly, He Shou Wu (Polygonum Multiflorum, Item No.1292) may be taken. 


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