Chinese Herbal Prescriptions for Constipation
Traditional Chinese Medicine (TCM) has extensive experiences and many effective remedies for constipation. These remedies are particularly suitable for constipation due to dysfunctional intestines, such as those occurring in irritable bowel syndrome (IBS), during the recovery period from diseases, rectal or anal damage, drug-induced, endocrine and metabolic issues, or bedridden patients. Individuals are treated according to their specific health needs, also known as tailoring treatments, based on syndrome differentiation.
During that consultation for constipation, TCM physicians pay attention to details such as an acute or chronic onset, changes in the stools, and accompanying abdominal or general signs, the information helps identify disharmony patterns of their patients. Some considerations for diagnosing constipation include:
- Infrequent bowel movements without straining: This may indicate spleen weakness, where the organ fails to distribute body fluids effectively throughout the body, leading to inadequate intestinal lubrication. As a result, the flow of the intestinal contents is sluggish, causing infrequent but non-straining constipation.
- Post-surgery: This is usually due to sluggish movement inside the intestines. Individuals may also have signs like abdominal bloating or pain, vomiting, and lack of bowel sounds or farting.
- During or after acute feverish illness: This is usually due to excess heat inside the body that leads to yin fluid depletion, and fails to moisten the large intestine.
- Emotional distress: Individuals usually develop qi stagnation in the intestines, they often have abdominal distention or pain, and changes in the stools.
- Post-natal, chronic illness, aged or weak: These usually involve depletion of blood and qi.
- Hemorrhoids and anal problems: These can find a localized lesion in the anal region.
Common Disharmonies in Constipation and Herbal Prescriptions
1. Heat pattern: constipation with a red face
Individuals usually have heat accumulating in the stomach and intestines, or result from depletion of body fluids after feverish illness. They have trouble bowel habits, passing dry stools, abdominal bloating or pain, a red face, sensitive to heat temperatures, sweating, oral sores, dry mouth, bad breath, irritability or restless, scanty and yellow urine. On examination, the tongue is red with a yellow dry coating, the pulse is slippery and rapid.
Herb selections will aim to:
- Unblock fu-organ and purge fire: Chinese rhubarb, immature bitter orange, and magnolia bark.
- Moisten intestines and facilitate bowel movements: hemp seed, apricot kernel, and crystalized honey.
- Nourish yin and harmonize internal environment: peony root
- In case individuals have obviously low fever, dry mouth, and thirst, then add dendrobium and fragrant Solomonseal rhizome for nourishing yin and promoting fluid production.
- In case having a bitter taste in mouth, red eyes, irritability and a bad temper, then add astragalus root and Chinese gentian root to clear the liver fire.
2. Sluggish pattern: constipation with greasy tongue coating
Individuals usually have sluggish qi movements in the large intestine, making the bowel movements slow down and the waste substances stay for too long. They pass dry and hard stools, or not so hard stools but need straining to pass them out, an incomplete feeling afterward, strong bowel sounds, frequent farting, abdominal bloating or pain, chest or rib side stuffiness, frequent belching and poor appetite. On examination, the tongue has a thin greasy coating, the pulse is taut.
Qi herbs are usually selected for this pattern, such as costus root (to regulate qi activity), combined spicebush root (to smooth qi flowing), Chinese eaglewood (to make qi flowing downward), while Chinese rhubarb, betel nut and immature bitter orange are used to resolve qi stagnation and rectify normal qi flowing.
- For stubborn cases, add extra herbs like magnolia bark, nutgrass flatsedge rhizome and bupleurum root to enhance the qi regulating effects.
- In case if the qi stagnation has persisted for a long time, that further transformed to fire, then add herbs like baical skullcap root, gardenia fruit and Chinese gentian root to purge the fire pathogens.
- In case individuals experience vomiting, add pinellia tuber, Japanese inula flower and red ocher to rectify qi flowing and improve the reversed qi state in the intestines.
- For depressed and indifferent mood, add herbs like peony root, bupleurum root and mimosa tree bark to light up the mental state.
- In case if qi stagnation combining with blood stasis, that individuals feel pain, and have a darken tongue body, then add herbs like peach kernel, Chinese safflower and red peony root.
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| costus root | combined spicebush root | immature bitter orange |
3. Deficient pattern: constipation with fatigue
Individuals usually have qi deficiency in the lungs or spleen, that are unable to support or motivate the bowel movements. They have trouble in passing stools, straining every time even though they have an strong urge, the stools are normal in texture. There will also be fatigue, sweating, short breath, low spirit, paleness and general weakness. On examination, the tongue body is pale, and the pulse is forceless.
Herb selections will aim at invigorating the organs to support bowel movements; astragalus root can be used for replenishing qi in the lungs and spleen; hemp seed and crystalized honey are for moistening the intestines and facilitating bowel movements; tangerine peel is for regulating qi.
In case there is a heaviness sensation in the anal region, add herbs like bugbane rhizome and bupleurum root to uplift middle qi.
4. Cold pattern: constipation with clear urine
Individuals usually have depletion of kidney yang, that fails to propel or activate the bowel movements. They have trouble passing stools, and profuse and clear urine. Other signs include night frequency, cold pain in the abdomen, limb coldness, sensitive to cold temperatures, and paleness. On examination, the tongue looks pale with a white glossy coating, the pulse is deep and slow.
Tonic herbs are selected, such as cistanche and achyranthes root, for warming and invigorating kidney yang, moistening intestines, and facilitating bowel movements. Angelica root can be used for enriching blood and lubricating intestines. Bugbane rhizome and oriental water-plantain rhizome can smooth digestive processes in the bowel. Sub-mature bitter orange helps intestinal contents travel through to the endpoint.
- In case individuals experience abdominal pain, then add costus root and cassia bark for pain relief;
- In case have vomiting, pinellia tuber and cardamon seed can be added for relief.
5. Dry pattern: constipation with skinny body
Individuals are usually in a yin deficiency state, that their body fluids and blood are depleted, and the intestines can’t get adequate lubrication. Besides constipation, they also have pale and lusterless complexion, palpitations, short breath, dream-disturbed sleep, a skinny physique, dry throat, pale nails and lips. On examination, the tongue is pale with a white coating, the pulse is thready.
Herb selections include angelica root and rehmannia root for nourishing yin and enriching blood; hemp seed and peach kernel for lubricating intestines and facilitating bowel movements; submature bitter orange helps intestinal contents travel through to the endpoint.
- For stubborn cases, extra herbs like figwort root, tuber fleeceflower root and wolfberry are selected to enhance bowel movements and lubricating intestines.
- When individuals have night sweats, hot flash, warm palms and soles, then add anemarrhena rhizome and figwort flower picrorhiza rhizome (hu huang lian) to clear the .
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| Chinese rhubarb | magnolia bark | dried tangerine peel |
It should be noted that the situation of constipation can change over time, and your disharmony pattern may not remain the same throughout treatment. Some individuals may even present in a mixed rather a simple pattern. It is important to find an experienced physician and be patient while working closely together. This way, you can find the best solution for your bowel health.
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