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Constipation is a decrease in the frequency of bowel movements accompanied by difficult, prolonged effort in passing dry and hard stools. It may be seen in various acute and chronic diseases.

Etiology and Pathogenesis

Although constipation is a disorder of the large intestines, it is closely related to the function of the spleen, stomach and kidneys. Since the stomach and large intestine are exterior-interior related, the heat retained in the stomach may move to the large intestine, leading to constipation. The spleen is the organ responsible for the digestion of food and the transportation of essential substances and for ascending clear materials and descending turbid materials. Deficiency of spleen-qi results in the impairment of these functions. The kidneys control urination and defecation, and insufficiency of kidney-yin and kidney-yang may cause difficulty in defecation. In sum, the causes of constipation are: retention of heat in the stomach and large intestine, insufficiency of body fluids, stagnation of qi, overstrain, dysfunction of internal organs, deficiency of qi and blood, etc. Based upon its causes, constipation is discussed under the categories of heat type, qi type, asthenic type and cold type.

Syndrome Differentiation and Therapeutic Principles

A. Syndrome differentiation

The etiology and pathogenesis of constipation are rather complicated and the accompanying symptoms vary a lot, so it should be differentiated into asthenia-syndrome and sthenia-syndrome clinically. Generally, constipation of heat type and qi type is attributed to sthenia-syndrome and that of asthenic type (deficiency of qi and blood) and cold type (deficiency of kidney-yang) to asthenia-syndrome.

B. Therapeutic principles

Purgation is not the only therapy for constipation, and the causative treatment aiming at its etiology and pathogenesis should be emphasized.

Classification and treatment

A. Heat Type

Manifestations: Constipation with distension of abdomen, dryness of mouth, halitosis, feverish sensation of body, red tongue with dry, yellow coating and smooth and rapid pulse.

Therapeutic principles: Clear away heat, and moisturize the intestine.

Prescription: The Modification of Potent Purgative Decoction \

Radix et Rhizoma Rhei 10 g
Cortex Magnoliae Officinalis 6 g
Fructus Trichosanthis 30 g
Rhizoma Anemarrhenae 10 g
Fructus Aurantii Immaturus 10 g
Semen Raphani 15 g

Remarks: Mix 6 grams of Natrii Sulfas Exsiccatus with the above decoction for cases with difficult effort in passing dry stool. Add Radix Scrophulariae, Radix Rehmanniae and Fructus Cannabis or Fructus Cannabis Pill for Moisturizing Intestine for those cases with thirst and dry, hard feces due to impairment of yin by heat.

B. Qi type

Manifestations: Constipation with distension of abdomen, eructation, hiccups, hypochondriac pain, frequent sighing, red tongue with thin, greasy coating and wiry and smooth pulse.

Therapeutic principles: Promote qi circulation and relieve dyspepsia.

Prescription: The Modification of Liumo Decoction

Radix Aucklandiae 10 g
Radix Linderae 10 g
Semen Arecae 10 g
Lignum Aquilariae Resinatum 6 g
Fructus Aurantii Immaturus 15 g
Radix et Rhizoma Rhei 10 g

Remarks: Add Radix Bupleuri and Radix Curcumae for cases with marked oppression of the chest and distention of hypochondrium. Add Radix Paeoniae Alba and Radix Angelicae Sinensis for those with severe abodminal pain. Add Rhizoma Pinelliae, Caulis Bambusae in Taeniam and haematitum, and omit Arecae for those cases with nausea and vomiting.

C. Asthenic type

Manifestations: Dry stool and difficulty in defecation, sweating, shortness of breath, fatigue and dizziness after defecation, spiritlessness, lusterless complexion, pale, corpulent tongue with thin, white coating and feeble and thready pulse.

Therapeutic principles: Benefit qi, nourish blood, and moisturize the intestine.

Prescription: The Modification of Astragali Decoction Radix Astragali 15 g
Radix Codonopsis Pilosulae 15 g
Radix Polygoni Multiflori 20 g
Radix Angelicae Sinensis 12 g
Pericarpium Citri Reticulatae 10 g
Fructus Cannabis 15 g
Radix Rehmanniae 15 g
Mel (mixed with decoction) 20 g

D. Cold type

Manifestations: dyschesia, cold pain in the abdomen, aversion to cold and desire for warmth, dark blue complexion, dizziness, poor memory, soreness and weakness of lumbus and knees, dull tongue with white, smooth coating and deep and slow pulse.

Therapeutic principles: Warm the kidneys, moisturize the intestine, and promote bowel movements.

Prescription: The Blood Replenishing Decoction

Herba Cistanchis 30 g
Rhizoma Alismatis 12 g
Radix Angelicae Sinensis 15 g
Fructus Cannabis 15 g
Radix Achyranthis Bidentatae 20 g
Rhizoma Cimicifugae 6 g
Radix Linderae 10 g

Aside from medication, physical exercise and mental, lifestyle and dietetic care may be beneficial for the aged with habitual constipation.

Experiential Prescriptions

A. Mel (honey) for enema

B. Semen Sesami, Fructus Juglandis and Semen Pini; prepared as powder; taken with Mel.

Copyright 1995 Hopkins Technology

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