Constipation

Constipation is mainly caused by the disturbed transmitting function of the large intestine and also related to the function of the spleen, stomach and kidney. In view of the difference in etiology and pathogenesis, this illness can be divided into two types; deficiency and excess.

After food is digested by the spleen and stomach, its refined nutrients are assimilated, and the wastes are egested through the transmission of the large intestine. If the stomach and intestines are diseased, various kinds of constipation occur in the following conditions: internal accumulation of dryness and heat, stagnation of qi, deficiency of qi with inability of transmission, blood deficiency with dryness of the intestines, and agglomeration of cold.

Constitutional yang preponderance, or indulgence in alcohol and spicy greasy food may lead to accumulation of heat in the stomach and intestines. Or after some febrile diseases, the remnant heat and insufficiency of body fluids give rise to dryness and heat in the intestines, and in addition, there may be disturbance of fluid distribution to the lower jiao. Constipation is present in any of the above cases.

Emotional factors, such as anxiety and depression, or lack of movement can cause stagnation of energy, impairing the transmitting function of the large intestine. As a result, the wastes are retained inside and unable to move downward and hence constipation.  

The coexistent deficiency of qi and blood can result from internal injury by overstrain or improper food intake, or happen after an illness or delivery or in the aged people. Qi deficiency results in weakness of the large intestine in transmission, while blood deficiency gives rise to shortage of body fluid, then the large intestine can no longer be moistened. Apparently both qi and blood deficiency can cause difficult evacuation of the feces, and hence constipation.

Constitutional debility or senile decay results in retention of the endogenous cold in the stomach and intestines. Consequently the yang qi is obstructed and the body fluid fails in distribution. Difficulty of the large intestine in transmission leads to constipation.

Excess condition

Main manifestations: Infrequent and difficult defecation from every three to five days, or even longer. In case of accumulation of heat, there are fever, dire thirst, foul breath, rolling and forceful pulse, yellow, dry tongue coating; in case of stagnation of qi, there are fullness and distending pain in the abdomen and hypochondriac regions, frequent belching, loss of appetite, thin sticky tongue coating and string - taut pulse.

Analysis: The large intestine is concerned with transmission. When there is accumulation of heat in the stomach and intestines, which consumes the body fluid or stagnation of qi, disturbing the normal function of the large intestine, constipation may result. Fever and dire thirst indicate internal preponderance of pathogenic heat. When the heat in the stomach and intestines causes evaporation, there is foul breath. The yellow and dry tongue coating reveals the damage of the body fluid by the heat, while the rolling and forceful pulse is a sign of excess in the interior. Emotional disturbance leads to stagnation of qi in the liver and spleen, thus resulting in frequent belching, and fullness and distending pain in the abdomen or hypochondrium. Since the spleen fails in transportation and transformation, there is loss of appetite. Thin, sticky tongue coating and string - taut pulse are the signs of disharmony between the liver and spleen.

Deficiency condition

Main manifestations: In cases of deficiency of qi and blood, pale and lusterless complexion, lips and nails, dizziness and palpitation, lassitude, shortness of breath, pale tongue with thin coating, thready and weak pulse; in cases of agglomeration of cold, pain and cold sensation in the abdomen, preference for warmth and aversion to cold, pale tongue with white and moist coating, deep slow pulse.

Analysis: Constipation can be caused either by qi deficiency, resulting in failure of the large intestine in transmission, or by blood deficiency with shortage of body fluid unable to moisten the large intestine. Endogenous cold stays in the stomach and intestines, leading to agglomeration of yin qi, failure of yang qi in transportation, and weakened transmission of the large intestine, and hence difficulty of defecation. Deficiency of qi and blood fails to ascend to nourish the upper portion, so there are pale and lusterless complexion and lips, lassitude and shortness of breath. In case of blood deficiency, the heart is poorly nourished, hence palpitation. When the head and eyes fail to be nourished, dizziness results. Since the nail is the external manifestation of the liver, there will be lusterless nails when the liver blood is insufficient. When cold is agglomerated, the circulation of qi is impeded, this accounts for the cold pain in the abdomen. Cold is of yin nature, and disorders caused by cold can be relieved by warmth, so there is preference for warmth and aversion to cold. Pale tongue with thin coating, thready weak pulse are the signs of insufficiency of qi and blood, while pale tongue with white, moist coating shows the internal cold due to yang deficiency.

General Approach

Method: The Back-shu and Front-mu points of the Large Intestine Meridian are mainly selected. For the excess condition the reducing method is applied to eliminate the heat, moisten the intestine, and remove the stagnation of qi, while for deficiency condition, the reinforcing method is used to reinforce qi and nourish blood, and moisten the intestines for defecation. Constipation due to cold can be relieved by moxibustion to warm the fu organ for defecation.

Prescription: [BL25 - ST25 - TH6 - KI6]

Accumulation of heat: [LI11 - LI4]

Stagnation of qi: [RN12 – LR3]

Deficiency of qi and blood: [BL20 – BL21 – ST36]

Agglomeration of cold: Moxibustion to RN8 and RN6.

Explanation

The causes of constipation are different, but they are common in impairing the transmitting function of the large intestine. Therefore, BL25 and the Front-mu point of the large intestine are applied to promote the flow of qi in the large intestine, the transmission can be regained when the qi of the fu organ flows smoothly. TH6 can promote the flow of qi in the three jiao. When the qi in the three jiao is in normal circulation, the qi of the fu organ will circulate freely. TH6 combined with KI6 is a principal point in treating constipation. LI11 and LI4 can reduce the heat from the large intestine. RN12, the Influential Point of the fu organs, is selected to lower the qi of the fu organ. The reducing method applied to LR3 is to soothe the liver qi. Reinforcing to BL20, BL21 and ST36 is able to reinforce qi in the spleen and stomach. Once the spleen and stomach qi is vigorous, qi and blood can be produced as a natural consequence, so this is the approach of treating the root cause of constipation in deficiency conditions. Moxibustion to RN8 and RN6 is offered to reduce cold and loosen the bowels.

Excess Yangming Heat

fullness in the intestines, may be pain (particularly on pressure), bad breath, thirst, T- red with yellow coat, P- slippery full

P/T – clear Heat, induce bowel movement, protect body fluids

Acupuncture – sedate, yangming, *LI 4, 11, *ST 37, 25, *SP 14

• thirst, fever – RN 23, HT 8
• bad breath – RN 24, MH 8

Large Intestine Qi stagnation

unfinished feeling, bitty stools, difficult to pass, bloated, belching, T- white coat, P- wiry

P/T – regulate Qi, induce bowel movement

Acupuncture – sedate, Ren, foot jueyin, RN 12 & ST 25, *Ren 6 (move intestines), LR 2 & GB 34

• hypochondriac pain – LR 14, TH 6
• bloating – SP 15

Spleen Stomach Qi deficiency

lack of Qi and blood can lead to Lung Qi deficiency, lack of energy to push out stool, sweating and fatigue after bowel movement, T- pale with white

coat, P- thin weak

P/T – strengthen Spleen, nourish Qi, induce bowel movement

Acupuncture – tonify, moxa, BL 20, 21, SP 6, ST 36, Ren 4, BL 25 & ST 25, KI 7 & LI 4

• palpitations – MH 6

Spleen Kidney Yang deficient Cold

Fatigue, coldness, dizzy, tinnitus, copious clear urine, T- pale, with white moist coat,

P- deep retarded

P/T – warm Spleen and Kidney Yang

Acupuncture – tonify , moxa, foot shaoyin and taiyin, RN 6, KI 6, 18, BL 23, 20 & SP 6, ST 25

• excess coldness – DU 4, BL 40
• anal prolapse – DU 1, 20

Yin/Blood deficiency

Chronic, rabbit stools, whole body Yin deficient signs, dryness

P/T – moisten dryness, nourish Yin

Acupuncture – Shu, foot shaoyin, KI 3, 6, BL 20, SP 6, ST 36, BL 25 & ST 25

• insomnia, palpitations – HT 7, LR 2 or 3
• dry mouth – jin jin, yue ye

Auricular – LI, rectum, SI, sympathetic, medium to strong stimulation, leave for 1-2 hours injection – jian wei and abdominal ashi points, LI 7, vitamin B 0.3-0.5 ml each, daily breathing, regulate diet, train body to have regular bowel movement times of the day.