Treatment of Constipation
In traditional Chinese medicine, constipation is treated according to syndrome differentiation and treatment based on addressing the root cause. The general therapeutic principles are: for real syndromes, clear heat and purge the bowels or regulate qi and guide stagnation; for deficient syndromes, tonify qi and nourish blood, or generate body fluids and moisten dryness, or warm and open blockages.
1. If there is hard stool, difficulty in defecation, prolonged intervals between bowel movements, accompanied by bad breath, bitter taste, irritability, anger, abdominal distension, poor appetite, and short, red urine, it belongs to heat constipation. Treatment should clear heat and purge the bowels, or clear heat and moisten the intestines. Use Tiaowei Chengqi Tang (rhubarb, mirabilite, licorice) for clearing heat and purging the bowels; use Mahuang Ren Wan (rhubarb, Citrus aurantium, magnolia bark, hemp seeds, apricot kernels, white peony root, honey) for clearing heat and moistening the intestines. Add radix et rhizoma sophorae flavescentis and flos sophorae if there is dry stool with painful defecation and anal fissure bleeding. Increase large belly peel and fried four herbs if there is abdominal distension and poor appetite. Combine Gengyi Pill or Danggui Luhui Pill if there is red eyes, bitter mouth, and wiry slippery pulse.
2. If there is hard or soft stool, desire to defecate but unable to, incomplete evacuation, worsening symptoms during emotional distress, accompanied by chest and flank fullness, abdominal distension and pain, it belongs to qi constipation. Treatment should regulate and promote qi movement. Use Liu Mo Tang (Citrus aurantium, sandalwood, wu yao, agarwood, betel nut, rhubarb). Additional herbs such as gardenia, lagenaria, peach kernel, apricot kernel, and red peony root may be added based on condition.
3. In elderly or chronically ill individuals, despite having the urge to defecate, they struggle weakly at the toilet, experience difficult and unsmooth bowel movements, with non-hard stool, followed by sweating and shortness of breath—this is qi deficiency constipation. Treatment should strengthen spleen and tonify qi. Use Huangqi Tang (astragalus, licorice, tangerine peel, hemp seed, honey). If there is qi sinking with a sensation of rectal prolapse and repeated straining without results, add rhizoma cimicifugae and radix bupleuri.
4. After childbirth or surgery, if stools are dry and ball-like, normal frequency but difficult defecation, accompanied by dizziness, palpitations, pale complexion—this is blood deficiency constipation. Treatment should nourish blood and moisten dryness. Use Runchang Wan (Angelica sinensis, raw rehmannia, peach kernel, hemp seed, citron shell). If there is also lower back soreness and light menstrual flow, add prepared polygonum multiflorum and cistanche.
5. If defecation is extremely difficult, stool either dry or not dry, cold intolerance, cold limbs, abdominal cold pain or lower back cold pain—this is yang deficiency cold constipation. Treatment should warm and open the obstruction. Use Jichuan Jian (Angelica sinensis, cistanche, achyranthes, rhizoma cimicifugae, citron shell, alisma). Add polygonum multiflorum, walnut meat, and cinnamon. If cold is severe, combine with Banliu Wan.
In addition to compound prescriptions, single herbs and empirical formulas often yield good results, such as senna leaf, cassia seed, raw white atractylodes, and radish seed.
Western medicine treats constipation with the advantage of ease of administration. Based on mechanisms of action, they are categorized into three types:
First, stimulant laxatives. These drugs and their metabolites directly stimulate the intestinal wall, enhancing intestinal motility and promoting fecal expulsion. Examples include Dulcolax tablets, castor oil, and rhubarb. These are the most commonly self-administered drugs by constipated patients. However, long-term use may lead to decreased intestinal responsiveness as a side effect, so they should not be used frequently.
Second, osmotic (diluting) laxatives, also known as bulk-forming laxatives. These prevent water absorption in the intestine, increasing intestinal content volume. They are poorly absorbed orally and create high osmotic pressure in the intestine, drawing in water and increasing fecal mass. The increased volume mechanically stretches the intestine, stimulating motility and promoting defecation. Examples include magnesium sulfate and sodium sulfate (mirabilite).
Third, lubricant laxatives, such as liquid paraffin and edible oils. These lubricate the intestinal lining and soften stool, facilitating easier passage. Liquid paraffin is not absorbed when taken orally or via enema, and it also hinders water absorption in the intestine. While ideal as a laxative, it may stain underwear. Long-term use interferes with absorption of vitamins A, D, K, calcium, and phosphorus.
Select laxatives based on duration of action. Osmotic laxatives act quickly—within 4–6 hours after ingestion, resulting in watery stools, often accompanied by abdominal pain. They are suitable for acute or refractory constipation but should not be used long-term; drink plenty of water after taking them. Stimulant laxatives act slowly and are best taken before bedtime, producing bowel movements 6–8 hours later. Lubricant laxatives suit elderly or frail individuals. Take 10–20 mL of liquid paraffin before bed each night; defecate the next morning, helping establish a conditioned reflex for regular bowel movements.
Pregnancy and menstruation generally contraindicate strong laxatives. In cases of organic intestinal diseases such as intestinal obstruction, laxatives are usually avoided.
Precautions when using laxatives:
1. Since different laxatives have distinct mechanisms, understand their properties, usage, dosage, and contraindications before use to avoid errors. Choose accordingly based on purpose: for bowel cleansing, use potent drugs; for clearing heat and promoting defecation, use bitter-cold laxatives; for moistening the intestines and relieving constipation, select mild, moisturizing laxatives.
2. As all laxatives have potential side effects, they should generally not be used long-term. If long-term use is necessary, alternate drug types regularly. Different laxatives vary in mechanism and effect; alternating them helps reduce adverse reactions.
3. Start with the lowest possible dose. The body develops tolerance to laxatives; prolonged use reduces efficacy. Some people initially find one Dulcolax tablet effective, but over time require up to ten tablets without effect. Excessive dosage increases side effects. Therefore, always start with minimal dosage. If diarrhea occurs after taking the drug, reduce the dose next time. If stool remains dry, gradually increase dosage or switch to another laxative.
4. Pay attention to timing. Moistening laxatives are best taken once before bedtime each evening, with defecation in the morning, aligning with natural bowel habits and aiding in correcting constipation. Most laxatives require a certain time after ingestion before bowel movements occur. Duration varies by drug type and dose, and individual sensitivity differs. Some people, upon not defecating within expected time, may increase dosage, leading to diarrhea, which is counterproductive.
In summary, due to differences in drug effects and individual sensitivity, adjust dosage through observation to achieve optimal effect—where stool is neither too dry nor too loose, avoiding both diarrhea and constipation.
For habitual constipation, acupuncture therapy may also be effective. Select points such as Tianshu (ST25), Zhigou (SJ6), and Shangjuxu (ST37). Use draining method for excess conditions, reinforcing method for deficiency; add moxibustion for cold conditions. For stomach and intestines with excessive heat, add Quchi (LI11), Hegu (LI4), Chize (LU5), and Neiting (ST44). For liver qi stagnation, add Taichong (LR3), Yanglingquan (GB34), and Qihai (CV6). For qi deficiency, add Pishu (BL20), Weishu (BL21), Dachangshu (BL25), and Zusanli (ST36). For blood deficiency, add Sanyinjiao (SP6), Zhaohai (KI6). For kidney yang deficiency, add Shenshu (BL23), Qihai (CV6), and Shendao (CV10). Alternatively, mash chopped green onion, mix with a little vinegar, stir-fry until hot, and apply to Shenque point (umbilicus); this method shows some effectiveness.
<Treatment of Constipation>