Recommended words
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Qi deficiency constipation with dry and soft stool.
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Blood deficiency constipation generally presents with overall dry stool.
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For qi deficiency constipation, use a large amount of Atractylodes (白术); for blood deficiency constipation, use a large amount of Angelica sinensis (当归).
Atractylodes needs to be used raw and must be crushed.
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An experienced Chinese medicine doctor thoroughly explains all constipation treatment methods; constipation, Angelica sinensis, Astragalus (黄芪), Licorice (甘草), Bupleurum (柴胡), Atractylodes (白术), Rhubarb (大黄), treatment methods
Constipation refers to reduced frequency of bowel movements or dry stools that are difficult to pass. Generally, no defecation for more than 2 days indicates constipation. Its etiology and clinical manifestations are relatively complex.
In traditional Chinese medicine (TCM), this disease has many names, such as “difficulty in defecation,” “postponed discharge,” “spleen constriction,” “stool retention,” “yin knot,” “yang knot,” “constipation,” “dry stool,” “intestinal knot,” “wind constipation,” “heat constipation,” “deficiency constipation,” “qi constipation,” “damp constipation,” “heat dryness,” “wind dryness,” etc.
When I just graduated and treated constipation, I strictly followed textbook treatments without much effect, which troubled me.
The textbooks described it this way, so why was the therapeutic effect lacking?
Later, I followed professors and famous doctors in various hospitals. Most of them also used rhubarb, hemp seed, and the like, which could only temporarily relieve constipation but not cure it long-term.
Therefore, I believed they had also not found a good method for treating constipation.
One day, I visited a department in a certain hospital and saw several books on the director’s desk, including one titled “Xinglin Xin Chuan” (杏林薪传). The director said to me, “This is a newly bought book, very good, you can read it when you have time.” So I bought a set to study at home.
I read it carefully several times and summarized that the main approach was to use formulas that tonify qi, regulate qi, and nourish blood and moisten dryness, largely using Atractylodes and Angelica sinensis.
Most dosages ranged from 60 to 120 grams, which surprised me as no book had ever mentioned such amounts. Would using this much be effective? Would there be side effects? Could the secret of Chinese medicine really lie in the dosage?
With such thoughts, I began to try the methods of Teacher Wang Xingfu.
My first patient treated with this method was a middle-aged woman whose main symptom was long-term constipation with dry and hard stool.
According to her description: She had suffered for more than 10 years, each bowel movement was very difficult, the stool was ball-shaped and bloody, and due to long-term constipation, she developed anal fissures causing great pain.
She usually took Sanhuang tablets, Intestinal Clear Tea, senna leaves and other laxatives, but this only relieved symptoms temporarily and did not cure the disease. Moreover, her constipation worsened with use. For over 10 years, she suffered greatly with no good solution.
The formula used was a modified Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with the following prescription:
Astragalus 20g, Angelica sinensis 30g, raw Atractylodes 60g (crushed), Cimicifuga (升麻) 10g, Bupleurum 10g, Codonopsis 10g, Chenpi 10g, Aurantii Fructus (枳壳) 10g, fried Licorice 6g.
Initially, 5 doses of the herbal medicine were prescribed, advising the patient to drink it warm before meals because I believed that taking it on an empty stomach would be more effective for constipation, aiding gastrointestinal lubrication and peristalsis.
This formula was directly copied from Teacher Wang’s book:
Fried Astragalus 20g, Angelica sinensis 50g, raw Atractylodes 120g, Cimicifuga 10g, Bupleurum 10g, Codonopsis 10g, Chenpi 10g, Aurantii Fructus 10g, fried Licorice 6g.
I only changed fried Astragalus to raw Astragalus, reduced Angelica sinensis by 20 grams, and raw Atractylodes by 60 grams; the raw Atractylodes must be crushed.
Why reduce the Angelica sinensis and raw Atractylodes dosage?
Because I feared that too large doses might cause side effects, so I started with less to observe the effect. This was also a manifestation of my cautious medication and self-protection accumulated during many years of practice.
Five days later, the patient returned for follow-up. Not knowing what results to expect, I anxiously inquired about the effects.
The patient reported: “Constipation has eased, but the effect is not obvious. The stool is less dry but bowel movement is still difficult. My energy is somewhat improved, and I have no discomfort after taking the medicine.”
— Chang Wen, Traditional Chinese Medicine, Qinhuangdao
Mastering Teacher Wang Xingfu’s constipation treatment method, subsequent constipation treatments became much more skillful.
However, what confused me was that sometimes the treatment effect was still not ideal. Was my syndrome differentiation wrong?
At the end of April 2018, Teacher Wang came to Qinhuangdao with senior apprentice brother Li Zhongwen for academic exchange. During several days of close contact, I learned many clinical TCM treatment secrets from Teacher Wang and Li Zhongwen.
When seeing Teacher Wang off at Qinhuangdao Train Station, I raised my doubts about constipation treatment.
Teacher Wang then pointed out the key points of constipation treatment on the spot:
1. Qi deficiency constipation has hard stool at the head that becomes soft later.
2. Blood deficiency constipation generally has overall dry stool.
3. For qi deficiency constipation, use a large amount of Atractylodes (白术), for blood deficiency constipation, use a large amount of Angelica sinensis (当归).
Atractylodes needs to be used raw and must be crushed.
Key points of constipation treatment in Teacher Xingfu’s book, for everyone to study:
TCM believes this disease is caused by excessive heat accumulation or qi stagnation, or cold congealing, or yin-yang qi-blood deficiency in the large intestine, leading to dysfunction of the large intestine’s transmission function.
In clinical practice, apart from excess constipation (this type can be relieved by Sanhuang tablets, hemp seed pills, rhubarb, and senna leaves), the more common types are qi deficiency constipation, blood deficiency constipation, and damp stagnation constipation. Therefore, I will discuss treatment experiences and methods of these aspects in detail.
- Qi deficiency constipation
Clinically, these patients often feel fatigued, eat less, have pale complexion and overweight body, stool is hard at first then soft, pulse is floating and soggy or deep and soggy and weak, tongue is pale with white coating.
The prominent symptom is difficult defecation, no bowel movement for several days, or hard stool with straining and bleeding.
This belongs to spleen deficiency with impaired transport and weak transmission, causing constipation. The obstruction is due to obstruction or deficiency, so the treatment principle is to supplement and relieve the obstruction, tonify qi, strengthen the spleen, and assist transportation.
The formula used is a modified Bu Zhong Yi Qi Tang: fried Astragalus, Angelica sinensis, raw Atractylodes, Codonopsis, Bupleurum, Cimicifuga, Chenpi, fried Licorice. My experience is to use Angelica sinensis at 30~50g and raw Atractylodes at 90~150g. This is crucial; otherwise, it is difficult to achieve efficacy.
[Case study one]
Wu, female, 45 years old. Diagnosed on October 12, 2006.
Constipation for 10 years, treated with phenolphthalein (fruit laxative), rhubarb, senna leaves, and Intestinal Clear Tea with mild improvement, but later symptoms worsened with more constipation despite treatment efforts. Tongue was pale, swollen, tender, with teeth marks on the edges, thin white coating, pulse was deep and weak. Diagnosed as spleen deficiency with impaired transport. Treatment principle: strengthen spleen and assist transport.
[Prescription] Fried Astragalus 20g, Angelica sinensis 50g, raw Atractylodes 120g, Cimicifuga 10g, Bupleurum 10g, Codonopsis 10g, Chenpi 10g, Aurantii Fructus 10g, fried Licorice 6g.
After 3 doses, stool softened and constipation significantly improved. Continued prescription for over 30 doses until cured.
[Case study two]
Diagnosis: Qi deficiency and impaired transport. Treatment principle: tonify qi, move spleen; when middle qi is supplemented, defecation will be smooth! Treated with Bu Zhong Yi Qi Tang.
[Prescription] Fried Astragalus 20g, Angelica sinensis 90g, raw Atractylodes 150g, Cimicifuga 10g, Bupleurum 10g, Codonopsis 10g, Chenpi 10g, Aurantii Fructus 10g, raw Rehmannia 30g, fried Licorice 6g.
The patient had a bowel movement after 1 dose, with yellow water and black lumps discharged. This was because stagnation antagonized the rhubarb effect; elderly qi and blood were both deficient and unable to transform properly. After 5 more doses, she was cured.
Licorice harmonizes the weak spleen and stomach qi and regulates other herbs.
The formula matches the disease mechanism and symptoms in the herbs, thus showing quick effect.
- Blood deficiency constipation
This condition is commonly seen in women postpartum and after chronic illness. Clinically, I often use Tao Hong Si Wu Tang (Peach Kernel and Safflower Four Substance Decoction) with modifications, which acts quickly. This syndrome differentiation is relatively simple.
[Case study]
Tian, female, 25 years old. Diagnosed on June 8, 2008.
[Prescription] Peach Kernel 12g, Safflower 6g, Angelica sinensis 90g, Ligusticum wallichii (川芎) 6g, Prepared Rehmannia 30g, Raw White Peony Root 30g, Curcuma 10g, Raw Barley Sprout 30g, Floating Wheat 30g, Biota seed 30g.
After 3 doses, the patient showed signs of improvement; stools were no longer dry and hard, defecation was not laborious. Continued 4 more doses, daily bowel movements normalized. Later, mainly used Xiao Yao Wan (逍遥丸), with Angelica sinensis increased to 60g, taken for a week. The mood improved and stools normalized without dryness.
- Damp stagnation constipation
Damp stagnation constipation commonly shows alternating dry and loose stools with difficult defecation.
Treatment can use San Ren Tang (Three Nuts Decoction) modified. The formula is: Apricot Kernel, Magnolia Bark, Pinellia, Aurantii Fructus, Poria, Akebia, Silkworm Sand each 12g, White Cardamom Peel, Atractylodes each 10g, Coix seed 30g, Artemisia capillaris 15g, Talcum 25g. Decoction once daily.
Efficacy: Unblock qi mechanism, transform dampness, and strengthen spleen transport.
[Case study]
At present, pulse is soggy, tongue is fully covered with greasy, slightly yellow coating, and urine is slightly yellow.
Diagnosed as qi stagnation and damp obstruction constipation. Treatment principle: promote qi circulation, transform dampness, and strengthen spleen transport. Prescribed modified San Ren Tang.
[Prescription] Apricot Kernel, Magnolia Bark, Pinellia, Aurantii Fructus, Poria, Akebia, Silkworm Sand each 12g, White Cardamom Peel, Atractylodes each 10g, Coix seed 30g, Artemisia capillaris 15g, Talcum 25g. One dose every two days, decocted.
After 6 doses, chest and epigastric fullness greatly reduced, appetite slightly increased, bowel movements once every 1-2 days but still unsatisfactory. After continuing 6 more doses of the original formula, bowel movements became smooth and once daily, then medication stopped. Followed up for half a year, bowel movements remained normal. — (Ancient Path Thin Horse Case Study)
This patient is a computer programmer who sits long with little movement; the spleen and stomach are weak, causing qi stagnation.
Spleen and stomach insufficiency leads to internal production of dampness, dampness obstructs the middle burner, weakens transport function, and disrupts fluid distribution; thus
Note: This article is sourced from the internet. Please use the prescriptions in the article only under professional TCM guidance and syndrome differentiation.
Analysis of specific herbs in the formula:
Astragalus
【Properties】Sweet, slightly warm.
【Functions and Indications】Tonifies Qi and secures the exterior; promotes pus discharge and tissue regeneration. Used for spontaneous sweating due to deficiency, chronic diarrhea, prolapse of rectum or uterus, chronic nephritis, deficiency edema, chronic ulcers, and wounds that do not heal easily.
Angelica sinensis
【Properties】Sweet, pungent, warm.
【Channels Entered】Heart, liver, spleen.
【Functions and Indications】Tonifies and harmonizes blood, regulates menstruation and relieves pain, moistens dryness and lubricates intestines. Used for irregular menstruation, amenorrhea, abdominal pain, masses, bleeding disorders; blood deficiency headaches, dizziness, limb weakness; dry stools and difficult defecation, recurrent dysentery; carbuncles, abscesses, trauma injuries.
Atractylodes
【Properties】Bitter, sweet, warm.
【Channels Entered】Spleen, stomach.
【Functions and Indications】Tonifies spleen, strengthens stomach, dries dampness, harmonizes the middle, calms fetus. Used for spleen and stomach qi deficiency, poor appetite, fatigue, shortness of breath, abdominal distension, diarrhea, phlegm retention, edema, jaundice, dampness arthralgia, urinary difficulty, dizziness, spontaneous sweating, restless fetus.
Cimicifuga (升麻)
【Properties】Sweet, pungent, slightly bitter, cool.
【Channels Entered】Lung, spleen, stomach.
【Functions and Indications】Raises yang, releases the exterior, vents rashes, detoxifies. Used for epidemic febrile diseases, headache, chills and fever, sore throat, mouth ulcers, rashes that do not surface; middle Qi collapse, chronic diarrhea, prolapse of rectum, vaginal bleeding, uterine prolapse; abscesses and sores.
Bupleurum (柴胡)
【Properties】Bitter, cool.
【Channels Entered】Liver, gallbladder.
【Functions and Indications】Harmonizes exterior and interior, soothes liver, raises yang. Used for alternating chills and fever, chest fullness and hypochondriac pain, bitter taste and tinnitus, dizziness, malaria, diarrhea with prolapse, irregular menstruation, uterine prolapse.
Codonopsis (党参)
【Properties】Sweet, neutral.
【Channels Entered】Enters the Qi aspect of the hand and foot Taiyin meridians according to “De Pei Ben Cao”.
【Functions and Indications】Tonifies middle Jiao, benefits Qi, generates fluids. Used for spleen and stomach deficiency, dual Qi and blood deficiency, fatigue, lack of appetite, thirst, chronic diarrhea, prolapse of rectum.
Chenpi (陈皮)
【Properties】Bitter, pungent, warm.
【Channels Entered】Lung, spleen.
【Functions and Indications】Regulates Qi, strengthens the spleen, dries dampness, transforms phlegm. Used for epigastric fullness and distension, poor appetite, vomiting, diarrhea, cough with excessive phlegm.
Aurantii Fructus (枳壳)
【Properties】Bitter, pungent, cool.
【Channels Entered】Lung, spleen, large intestine.
【Functions and Indications】Breaks Qi, moves phlegm, reduces accumulation. Used for chest and diaphragm phlegm stagnation, chest fullness, hypochondriac pain, food retention, belching, vomiting, post-diarrhea heaviness, prolapse of rectum, uterine prolapse.
Raw Rehmannia (生地黄)
【Properties】Fresh Rehmannia: sweet, bitter, cold.
【Channels Entered】Heart, liver, kidney.
【Functions and Indications】Clears heat, generates fluids, cools blood, stops bleeding. Used for yin injury from febrile disease, crimson tongue, thirst, rashes, vomiting blood, nosebleeds, sore throat.
Licorice (甘草)
【Properties】Sweet, neutral.
【Channels Entered】Spleen, stomach, lung.
【Functions and Indications】Harmonizes middle, relieves spasms, moistens lungs, detoxifies, harmonizes other herbs. Fried used for spleen and stomach deficiency, poor appetite, abdominal pain, diarrhea, fatigue-induced fever, lung atrophy cough, palpitations, convulsions; raw used for sore throat, peptic ulcers, abscesses and sores, antidote for poisonings.