Diagnosis and Treatment
I. Real Constipation
1. Accumulation of Heat in Intestines and Stomach
Symptoms: hard stool, abdominal distension and pain, red face, body heat, dry mouth and bad breath, restlessness, short and red urine, red tongue with yellow dry coating, slippery and rapid pulse.
Treatment: purge heat, guide stagnation; moisten and relieve constipation.
Formula: Ma Zi Ren Wan. The ingredients include Da Huang, Zhi Shi, Hou Po to purge heat and relieve stagnation; Ma Ren, Xing Ren, Bai Mi to moisten the intestines and relieve constipation; Shao Yao to nourish yin and harmonize the blood. If body fluids are depleted, add Sheng Di, Xuan Shen, Mai Dong to nourish yin and generate fluids. If there is liver qi stagnation due to anger, with red eyes, add Geng Yi Wan to clear liver and relieve constipation. If heat is not severe or bowel movement is unsatisfactory after medication, use Qing Lin Wan to gently relieve constipation and avoid recurrence. If heat is severe, with fullness, dryness, hardness, and accumulation, use Da Cheng Qi Tang to urgently purge and preserve yin. Other options include Dang Gui Long Hui Wan, Huang Long Tang, and Liang Ge San.
2. Qi Stagnation
Symptoms: hard stool, or not very hard, difficulty passing stool despite urge, incomplete evacuation, intestinal rumbling, abdominal distension and pain, chest and rib fullness, frequent belching, poor appetite, greasy coating, wiry pulse.
Treatment: regulate qi and guide stagnation.
Formula: Liu Mo Tang. Ingredients: Mu Xiang regulates qi, Wu Yao promotes qi, Chen Xiang descends qi, Da Huang, Bin Lang, and Zhi Shi break up stagnation. Can add Hou Po, Xiang Fu, and Chai Hu to enhance qi regulation. If stagnation has been long-standing and transforms into fire, add Huang Qin, Zhi Zi, and Long Dan Cao to clear liver fire. If there is nausea and vomiting, add Ban Xia, Xuan Fu Hua, and Dai Zhe Shi. If emotional distress leads to depression and silence, add Bai Shao, Chai Hu, and He Huan Pi to relieve depression. If constipation occurs after injury or surgery, due to qi stagnation and blood stasis, add Tao Ren, Hong Hua, and Chi Shao to activate blood and resolve stasis.
3. Cold and Phlegm Accumulation
Symptoms: difficult defecation, abdominal pain with cramping, distension and tenderness, pain on the left side, cold hands and feet, hiccups, vomiting, white greasy coating, wiry and tight pulse.
Treatment: warm interior, dispel cold, relieve constipation and pain.
Formula: Da Huang Fu Zi Tang. Fu Zi warms and disperses cold, Da Huang clears accumulation, Xi Xin disperses cold and relieves pain. Can add Zhi Shi, Hou Po, and Mu Xiang to enhance purgative effect; add Gan Jiang and Xiao Hui Xiang to increase cold-dispelling power. If there is sudden severe abdominal pain, clenched jaw, and fainting due to severe cold accumulation, use San Wu Bei Ji Wan to attack cold accumulation.
II. Deficient Constipation
1. Qi Deficiency
Symptoms: stool is not hard, but despite urge, straining is weak and ineffective, difficult to pass, sweating, shortness of breath, fatigue after defecation, pale face, lethargy, tired limbs, weak voice, pale tongue with white coating, weak pulse.
Treatment: tonify qi and moisten the intestines.
Formula: Huang Qi Tang. Huang Qi tonifies spleen and lung qi, Ma Ren and Bai Mi moisten the intestines and relieve constipation, Chen Pi regulates qi. If qi deficiency is severe, add Ren Shen and Bai Zhu. If there is prolapse due to qi sinking, use Bu Zhong Yi Qi Tang. If lung qi is insufficient, use Sheng Mai San. If deficiency persists and kidney qi is inadequate, use Da Bu Yuan Jian.
2. Blood Deficiency
Symptoms: hard stool, pale complexion, palpitations, shortness of breath, insomnia, vivid dreams, forgetfulness, pale lips, pale tongue with white coating, fine pulse.
Treatment: nourish blood and moisten dryness.
Formula: Run Chang Wan. Dang Gui and Sheng Di nourish blood and yin, Ma Ren and Tao Ren moisten and relieve constipation, Zhi Ke guides qi downward. Can add Xuan Shen, He Shou Wu, and Gou Qi Zi to nourish blood and moisten intestines. If there is internal heat due to blood deficiency, add Zhi Mu and Hu Huang Lian to clear deficiency heat. If yin and blood have recovered but stool remains dry, use Wu Ren Wan to lubricate the intestines.
3. Yin Deficiency
Symptoms: hard stool resembling sheep droppings, emaciated body, dizziness, tinnitus, red cheeks, restlessness, poor sleep, night sweats, sore waist and knees, red tongue with little coating, fine and rapid pulse.
Treatment: nourish yin and relieve constipation.
Formula: Zeng Ye Tang. Xuan Shen, Mai Dong, and Sheng Di nourish yin and generate fluids. Can add Shao Yao, Yu Zhu, and Shi Hu to enhance nourishing yin effects, and Ma Ren, Bo Zi Ren, and Gu Lou Ren to improve moistening of intestines. If stomach yin is deficient with dry mouth and thirst, use Yi Wei Tang. If kidney yin is deficient with sore waist and knees, use Liu Wei Di Huang Wan. If yin deficiency causes dryness and heat damages fluids, use Zeng Ye Cheng Qi Tang to increase fluids and facilitate bowel movement.
4. Yang Deficiency
Symptoms: hard or not hard stool, difficult to pass, clear and long urine, pale face, cold limbs, cold abdominal pain relieved by warmth, sore waist and knees, pale tongue with white coating, deep and slow pulse.
Treatment: warm yang and relieve constipation.
Formula: Ji Chuan Jian. Rou Cong Rong and Niu Xi warm and tonify kidney yang, moisten intestines, and relieve constipation; Dang Gui nourishes blood and moistens intestines; Sheng Ma and Ze Xie elevate clear and descend turbid; Zhi Ke relaxes the intestines and facilitates downward movement. For elderly people with cold constipation, use Ban Liu Wan. For spleen yang deficiency with cold accumulation, use Wen Pi Tang. For kidney yang deficiency, use Shen Qi Wan. Other options include Li Zhong Wan, Si Shen Wan, and You Gui Wan.
[Prognosis and Outcome]
If constipation persists, it may lead to hemorrhoids, anal fissures, affect digestion, and even cause turbid qi to rise, leading to various complications. For elderly, weak individuals, or those recovering from illness, constipation is often due to qi and blood deficiency, cold accumulation, so treatment should be gradual and not expect immediate results. In general, with active treatment and proper care involving diet, emotions, and exercise, most cases can recover within a short time.
[Prevention and Management]
For habitual constipation, maintain a cheerful mood, increase physical activity, pay attention to dietary adjustment, and establish regular bowel habits.
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