Constipation

Introduction	Back to Top
Although it's not a disease, constipation is a common clinical symptom, and it seriously affects the quality of life. Generally, people in good health defecate once a day or 3-4 times a week. Constipation refers to the difficulty in defecation or an abnormally long interval between defecations. Traditional Chinese medicine breaks the condition down into these subcategories: splenic constipation, yang constipation, and yin constipation, etc.

Etiology/Pathogenisis	Back to Top
Although it's not a disease, constipation is a common clinical symptom, and it seriously affects the quality of life. Generally, people in good health defecate once a day or 3-4 times a week. Constipation refers to the difficulty in defecation or an abnormally long interval between defecations. Traditional Chinese medicine breaks the condition down into these subcategories: splenic constipation, yang constipation, and yin constipation, etc.

Primary Treatments with Medicinal Herbs	Back to Top
Ma Zi Ren Wan Luo treated 50 cases of habitual constipation in the elderly with modified Ma Zi Ren Wan. The modified formula consisted of Ma Zi Ren (Semen Cannabis), Yu Li Ren (Semen Pruni), Gua Lou Ren (Semen Trichosanthis), Bo Zi Ren (Semen Biotae), Tian Hua Fen (Radix Trichosanthis), Mai Dong (Radix Ophiopogonis), Dong Gua Ren (Semen Benincasae), Lu Gen (Rhizoma Phragmitis), Ge Gen (Radix Puerariae), Da Huang (Radix et Rhizoma Rhei), and Gan Cao (Radix Glycyrrhizae). One course of treatment continued for 3 days. The results indicated that the treatment was effective in all 50 cases. Some patients experienced complete relief after taking as few as three doses of the formula.(1) Wu treated 55 cases of habitual constipation in middle-aged and older people with Ma Zi Ren Wan and modified Zeng Ye Tang. The combined formula consisted of Ma Zi Ren (Semen Cannabis), Ku Xing Ren (Semen Armeniacae Amarum), Zhi Shi (Fructus Aurantii Immaturus), Hou Po (Cortex Magnoliae Officinalis), Xuan Shen (Radix Scrophulariae), Sheng Di Huang (Radix Rehmanniae), Bai Shao (Radix Paeoniae Alba), Mai Dong (Radix Ophiopogonis), and Da Huang (Radix et Rhizoma Rhei). One dose of the formula was given as a decoction and was administered in two portions. The course of the treatment continued for 7 days. The results indicated that after two courses of treatment, 36 cases were resolved, another 15 cases had improved, and the remaining 4 cases did not respond to the treatment, with a total effectiveness rate of treatment 92.6%.(2)

Other Treatments with Medicinal Herbs	Back to Top
Bu Zhong Yi Qi Tang Fan treated 47 cases of intractable constipation with Bu Zhong Yi Qi Tang. The formula consisted of Huang Qi (Radix Astragali seu Hedysari), Gan Cao (Radix Glycyrrhizae), Dang Shen (Radix Codonopsis Pilosulae), Dang Gui (Radix Angelicae Sinensis), Zhi Shi (Fructus Aurantii Immaturus), Chen Pi (Pericarpium Citri Reticulatae), Sheng Ma (Rhizoma Cimicifugae), Chai Hu (Radix Bupleuri), and Bai Zhu (Rhizoma Atractylodis Macrocephalae). One dose of the formula in a decoction (with a spoonful of honey added) was administered daily, and one course of treatment lasted for 10 days. The results showed that after 1-6 courses of treatment, 39 cases were resolved, and the remaining 8 cases had improved.(3) Si Mo Yin Li treated 40 cases of chronic functional constipation with Si Mo Yin. The formula consisted of Mu Xiang (Radix Aucklandiae), Zhi Qiao (Fructus Aurantii), Bing Lang (Semen Arecae), and Wu Yao (Radix Linderae). The results indicated that after two weeks of treatment, 32 cases had significantly improved, another 4 cases improved, and the remaining 4 cases did not respond to the treatment.(4) Yun Chang Tong Bian Tang Sun treated 45 cases of chronic habitual constipation with Yun Chang Tong Bian Tang. The formula consisted of Dang Shen (Radix Codonopsis), Huang Qi (Radix Astragali seu Hedysari), Chai Hu (Radix Bupleuri), Sheng Ma (Rhizoma Cimicifugae), Xuan Shen (Radix Scrophulariae), Mai Dong (Radix Ophiopogonis), Ma Zi Ren (Semen Cannabis), Xing Ren (Semen Armeniacae Amarum), Shu Di Huang (Radix Rehmanniae Praeparata), and Dang Gui (Radix Angelicae Sinensis). One dose of the formula in a decoction was administered a day, orally. In addition, the patients drank 200ml of light saline on empty stomach each morning while under treatment. The course of treatment lasted 1 week. The results showed that 35 cases were resolved, another 6 cases had improved, and the remaining 4 cases did not respond to the treatment, with a total effectiveness rate of 91.1%.(5) Zhong's Constipation Formula Zhong treated 42 cases of constipation in the elderly by promoting blood circulation to remove blood stasis. The formula consisted of Hong Hua (Flos Carthami), Chuan Xiong (Rhizoma Ligustici Chuanxiong), Zhi Qiao (Fructus Aurantii), Dang Gui (Radix Angelicae Sinensis), Chi Shao (Radix Paeoniae Rubra), and Dan Shen (Radix Salviae Miltiorrhizae). One dose of the formula in a decoction was administered orally daily, and one course of treatment lasted for 20 days. The results showed that 26 cases were resolved, another 12 cases had improved, and the remaining 4 cases did not respond to the treatment, with a total effectiveness rate being 90.48%.(6)

Other Treatments	Back to Top
Massage therapy Zhang et al. treated 42 cases of infantile constipation with herbs and massage. Two parts of Da Huang (Radix et Rhizoma Rhei) and one part of Zhi Shi (Fructus Aurantii Immaturus) were ground into fine powder. A paste made of the mixed powder with vinegar was applied to the patient's navel daily, and the abdominal area was massaged twice a day. At the same time, the patients undertook a healthier diet and started potty-training. One course of treatment lasted for 3 days. The results: after one course of treatment, 18 cases had shown great improvement, another 22 cases had improved, and the remaining 2 cases did not respond to the treatment, with a total effectiveness rate of 95.24%.(7) Zhang et al. treated 145 cases of habitual constipation among the elderly with massage therapy combined with Tong Bian Gao (an herbal paste). The herbal paste consists of Da Huang (Rhubarb), Mang Xiao, Huo Ma Ren (Linum), Xing Ren (Apricot Seed), salt (Sal), Zhi Shi (Immature Bitter Oranges), and Ma You (Sesame oil). The acupoints used were Zhong Wan (Ren 12), Tian Shu (St 25), Da Heng (Sp 15), Wei Shu (UB 21), and Da Chang Shu (UB 25). In addition, massage was also performed on the navel, abdomen, spine, and Urinary Bladder Channel. The results: 102 cases were resolved, 20 cases improved greatly, another 18 cases improved somewhat, and the remaining 5 cases did not respond to the treatment.(8)

Acupuncture & Acupressure	Back to Top
Gao, et al. treated 40 cases of constipation with otopuncture. Bilateral lung-related otopoints were selected for this treatment. The otoneedles were used to puncture the ear cartilage without piercing through it and then covered the needle handles with adhesive plaster. The results showed that the treatment had a total effectiveness rate of 95%.(9) Li treated 34 cases of paralytic intestinal obstruction after surgery with acupuncture. The acupoints selected for this treatment were Zu San Li (He-Sea Point, St 36), Shang Ju Xu (St 37), and Xia Ju Xu (St 39). Needles were rapidly inserted, maneuvered using the lifting-thrusting-twirling-reducing method, and were retained for 30 minutes. The treatment was conducted once or twice a day. The results illustrated that after 8 sessions of treatment, 22 cases were resolved, and the remaining 12 cases had improved.(10) Otopoint plastering therapy Yuan treated 35 cases of constipation with auricular-plaster therapy. Selected for treatment were otopoints related to the following areas: the lung, the large intestine, the lower section of the rectum, endocrine, sympathetic nerves, and the brain. A viccaria seed was pressed against the auricular-point and covered with adhesive plasters, then press the auricular-point for 10 minutes every 2 hours. The treatment was repeated every 3 days, and one course of treatment lasted for 15 days. The results indicated that 20 cases were resolved, and the remaining 15 cases improved.(11) Min treated 52 cases of constipation with auricular-plaster therapy. Acupoints were selected for treatment as follows: for patients with excessive heat in the large intestine, otopoints related to the large intestine, lower section of the rectum, abdomen, and feet were treated; for patients with liver-qi stagnation, otopoints related to the liver, stomach, brain, and large intestine were treated; and for patients with qi and blood deficiencies, otopoints related to the spleen, lung, tri-jiao, and large intestine were treated. Oil rapeseeds were (Semen Brassicae Oleiferae) adhered onto a small piece of adhesive plaster, which was then placed on the selected otopoints. The plaster was gently pressed for 1-2 minutes. The patients were instructed to press the treated otopoints 5-6 times a day, 1-2 minutes each time. One course of treatment required applying the plaster 4 times. The study results showed that the treatment had a total effectiveness rate of 85%.(12) Combined Otopoint plastering Therapy with Herbs Huang et al. treated 53 cases of constipation in the elderly with herbs and otopoint plastering therapy. The treatment selected otopoints related to the large intestine, small intestine, spleen, stomach, and endocrine as the principal points for treatment. Supplemental treatments were applied to otopoints related to sympathetic nerves, under the cortex, Shenmen (H 7), and tri-jiao. Vaccaria seeds (Semen Vaccariae) were adhered onto a small piece of adhesive plaster, which was then placed on the mentioned otopoints, and the course of treatment lasted a month. In addition, the patients took Ma Zi Ren Wan 6 g, 1-2 times a day. The results of the study showed that 12 cases were resolved, 24 cases had shown great improvement, another 12 cases had improved somewhat, and the remaining 5 cases did not respond to the treatment, with a total effectiveness rate of treatment being 90%.(13) Guo et al. treated 31 cases of constipation with herbs and acupuncture. Patients with damp-heat in the large intestine were administered modified Ma Zi Ren Wan; patients with liver-spleen incoordination were administered modified Long Dan Xie Gan Tang; and patients with qi and blood deficiencies were administered Bu Zhong Yi Qi Tang and modified Si Wu Tang. All of the patients received the acupuncture treatment at acupoints<

Footnotes	Back to Top
¹ Luo Qiu Bo. Treating 50 cases of senile habitual constipation with Ma Zi Ren Wan. Zhejiang Journal of Integrated Medicine. 2000;10(3):170-171. ² Wu Zhen Xi. 55 cases of senile constipation treated with Ma Zi Ren Wan and modified Zeng Ye Tang. Journal of New TCM. 2000;32(1):18. ³ Fan Hua. 47 cases of refractory constipation treated with Bu Zhong Yi Qi Tang. Journal of Chinese Folk Medicine. 1999;7(12):39-40. ⁴ Li Xin Cheng. Chronic functional constipation treated with Si Mo Yin. Hubei Journal of Traditional Chinese Medicine. 1999;22(2):54. ⁵ Sun Feng. 45 cases of constipation treated self-formulated Yun Chang Tong Bian Tang. Anhui Journal of TCM Clinical Application. 1999;11(1):7. ⁶ Zhong Chuan Zhen. 42 cases of senile constipation treated by promoting blood circulation to remove blood stasis. Journal of Applied TCM. 1999;15(7):14-15. ⁷ Zhang Li Min, et al. 42 cases of infantile constipation treated with Tong Bian San paste and massage. Journal of External Application of Traditional Chinese Medicine. 1999;8(3):47. ⁸ Zhang Xiao Ting, et al. 145 cases of senile habitual constipation treated by massage with Tong Bian Gao. Journal of Shang TCM University. 1999;23(6):453-454. ⁹ Gao Gui Rong, et al. 40 cases of constipation treated with otopuncture. Shaanxi Journal of Traditional Chinese Medicine. 2000;21(6):270. ¹⁰ Li Jing Ming. 34 cases of paralytic intestinal obstruction after surgery treated with acupuncture. Journal of New TCM. 1999;31(5):23. ¹¹ Yuan Hai Yan. 35 cases of constipation treated with otopoint plastering therapy. Journal of Chinese Acupuncture. 1999;19(1):18. ¹² Min Xue Jin. 52 cases of constipation treated otopoint pressure therapy. Journal of TCM Research. 1999;15(1):18-19. ¹³ Huang De Bao, et al. 53 cases of senile constipation treated with herbs and otopoint pressure therapy. Chinese Journal of Convalescence. 1989;4(4):183.