Chronic Constipation

Constipation is characterized by a reduced frequency of bowel movements, hard stools, and/or difficulty passing stool. A reduced frequency means fewer than 3 bowel movements per week. Difficulty passing stool includes straining, difficulty passing stool, a feeling of incomplete evacuation, prolonged time spent defecating, and the need for manual assistance. Chronic constipation lasts for at least 6 months.

TCM Pattern Differentiation and Medication Reference

|Common Symptoms

Clinical Description:

Dry, hard stools; abdominal distension and pain; dry mouth and bad breath; scant, dark-yellow urine; flushed face and a sensation of heat; red tongue; yellow or yellow, dry coating; slippery, rapid pulse

Plain-Language Explanation:

  • Stools are dry and hard, and passing them takes effort.
  • The abdomen feels bloated and painful, with uncomfortable pressure.
  • The mouth feels dry, and the breath has an unpleasant odor.
  • Urine is scant and dark yellow, appearing more yellow than usual.
  • The face may look flushed, and the body may feel hot and uncomfortable.
  • The tongue appears red overall.
  • The tongue coating is yellow, or yellowish and dry, and the tongue surface may appear dry.
  • The pulse feels slippery and faster than usual.

|Treatment Approach

Clinical Description:

Clear heat and remove stagnation; moisten the intestines and promote bowel movements

Plain-Language Explanation:

  • This approach is intended to clear internal heat and help move what has become stagnant, easing the sense of blockage.
  • It is intended to moisten the intestines so bowel movements may be easier and more comfortable.

|Related Products

The products below are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.

|Common Symptoms

Clinical Description:

Difficulty passing stool and an urge to defecate without being able to; in severe cases, abdominal distension; frequent belching; pale-red tongue; thin, greasy coating; wiry pulse

Plain-Language Explanation:

  • Bowel movements are difficult, and there is often an urge to go without being able to pass stool.
  • In more severe cases, the abdomen may become distended and feel uncomfortably full.
  • Frequent, repeated belching may occur, as if gas is rising from the stomach.
  • The tongue appears pale red overall.
  • The tongue coating is thin and greasy, with a somewhat sticky appearance.
  • The pulse feels taut, like a stretched string.

|Treatment Approach

Clinical Description:

Regulate Qi and resolve stagnation; promote downward movement and bowel evacuation

Plain-Language Explanation:

  • This approach is intended to regulate the body’s Qi, helping it move more smoothly and easing stagnation.
  • It uses a downward-moving approach to encourage bowel movements and make passing stool easier.

|Related Products

The products below are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.

|Common Symptoms

Clinical Description:

Difficulty passing stool; dry, hard, pellet-like stools; fatigue after defecation; dry mouth and yellow urine; soreness and weakness in the lower back and knees; dull complexion; dizziness and palpitations; fatigue and shortness of breath; pale tongue; thin or weak pulse

Plain-Language Explanation:

  • Passing stool is difficult and takes effort.
  • Stools are dry, hard, and shaped like pellets.
  • There may be noticeable fatigue after a bowel movement.
  • The mouth feels dry, and urine appears yellow and darker than usual.
  • The lower back and knees may feel sore, weak, or lacking in strength.
  • The complexion may look dull and lack color.
  • Dizziness and palpitations may occur, with an unsettled heartbeat.
  • There may be fatigue and shortness of breath, with a feeling of not getting enough air.
  • The tongue appears pale overall.
  • The pulse feels either thin or weak.

|Treatment Approach

Clinical Description:

Nourish the kidneys and replenish essence; support Qi and blood; moisten the intestines and promote bowel movements

Plain-Language Explanation:

  • This approach aims to nourish the kidneys and replenish “essence,” supporting the body’s reserves and easing discomforts such as soreness and weakness in the lower back and knees, tinnitus, forgetfulness, low energy, and frequent dreams at night.
  • It aims to support Qi and nourish the blood, helping replenish energy and nourishment and ease fatigue, shortness of breath, weakness, a pale complexion, dizziness, and palpitations.
  • It aims to moisten the intestines and soften stools so bowel movements may be easier, helping ease dry, hard stools, straining, abdominal distension or pain, and a feeling of incomplete evacuation.

|Related Products

The products below are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.

|Common Symptoms

Clinical Description:

Difficulty passing stool despite an urge; straining may cause sweating and shortness of breath; fatigue after defecation; pale face and low energy; tired limbs and reluctance to speak; pale tongue with white coating; weak pulse

Plain-Language Explanation:

  • Passing stool is difficult, even with an urge to go, and it takes effort.
  • Straining to pass stool may cause sweating and shortness of breath.
  • There may be noticeable weakness after a bowel movement.
  • The face may look pale and dull, and the person may feel fatigued and low in energy.
  • The limbs may feel tired and weak, and there may be little desire to speak.
  • The tongue appears pale overall.
  • The tongue is covered with a white coating.
  • The pulse feels weak and lacking in strength.

|Treatment Approach

Clinical Description:

Supplement Qi and moisten the intestines

Plain-Language Explanation:

  • This approach aims to replenish Qi and support digestive function, helping ease fatigue, shortness of breath, weakness, poor appetite, and bloating after meals.
  • It aims to moisten the intestines and soften stools so bowel movements may be easier, helping ease dry, hard stools, straining, constipation, abdominal distension, and a feeling of incomplete evacuation.

|Related Products

The products below are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.

|Common Symptoms

Clinical Description:

Straining and difficulty passing stool; clear, copious urine; pale, lustreless complexion; cool limbs; preference for warmth and aversion to cold; cold abdominal pain or soreness and coldness in the lower back and knees; pale tongue with white coating; deep, slow pulse

Plain-Language Explanation:

  • Passing stool is difficult and takes effort.
  • Urine is clear and pale, and urination may take longer than usual.
  • The face looks pale, with an overall washed-out appearance.
  • The limbs feel cool to the touch.
  • There is a preference for warmth and an aversion to cold; cold weather may make discomfort worse.
  • The abdomen has a cold, aching pain, as if chilled.
  • There may also be soreness and a cold sensation in the lower back and knees.
  • The tongue appears pale overall.
  • The tongue coating is white.
  • The pulse feels deep and slow.

|Treatment Approach

Clinical Description:

Warm Yang and promote bowel movements

Plain-Language Explanation:

  • This approach aims to warm the body’s Yang and activate intestinal function that may be inhibited by cold, easing constipation, straining, abdominal distension, and pain so bowel movements may be easier.
  • It also aims to dispel internal cold and ease symptoms such as feeling cold, cold hands and feet, a dull aching cold sensation in the lower back or abdomen, and clear, copious urine.

|Related Products

The products below are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.

|Common Symptoms

Clinical Description:

Dry, hard, pellet-like stools; dry mouth and reduced saliva; irritability and poor sleep; episodic sensations of heat and night sweats; red tongue with scant coating; thin, rapid pulse

Plain-Language Explanation:

  • Stools are dry, hard, and pellet-like, and may be difficult to pass.
  • The mouth feels dry, and there is less saliva than usual.
  • There may be irritability and poor sleep.
  • There may be episodes of feeling hot and sweating during sleep.
  • The tongue appears red overall.
  • There is very little coating on the tongue, which may appear almost bare.
  • The pulse feels thin and fast.

|Treatment Approach

Clinical Description:

Nourish Yin and promote bowel movements

Plain-Language Explanation:

  • This approach aims to nourish and replenish the body’s fluids, moisten the intestines, and make bowel movements easier, helping ease dry, hard stools, straining, constipation, abdominal distension, and a feeling of incomplete evacuation.
  • It also aims to ease dryness and internal heat associated with insufficient Yin fluids, including dry mouth and throat, dry skin, heat in the palms and soles, and night sweats.

|Related Products

The products below are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a doctor or pharmacist.

References

  1. Guo Xiaofeng, Ke Meiyun, Pan Guozong, et al. A cluster-sampled, stratified, randomized epidemiological survey of chronic constipation and related factors in adults in Beijing[J]. Chinese Journal of Digestive Diseases, 2002(22): 637-638.
  2. Xiong Lishou, Chen Minhu, Chen Huixin, et al. An epidemiological study of chronic constipation in community populations in Guangdong Province[J]. Chinese Journal of Digestive Diseases, 2004(24): 488-491.
  3. Zhi Yong, Yang Guangen, Shen Zhong, et al. An epidemiological survey of constipation in urban Hangzhou[J]. Chinese Journal of Digestive Diseases, 2004(24): 435-436.
  4. Rome Committee. Rome III diagnostic criteria for functional gastrointestinal disorders[J]. Modern Digestion & Intervention, 2007, 12(2): 137-140.
  5. China Association of Chinese Medicine. Guidelines for the diagnosis and treatment of functional constipation[J]. Chinese Medicine Modern Distance Education of China, 2011, 9(17): 127-128.
  6. Chinese Pharmacopoeia Commission. Pharmacopoeia of the People’s Republic of China (2015 Edition)[M]. Beijing: China Medical Science Press, 2015.