Constipation

Constipation

Both urination and defecation are outlets for the spleen and stomach. Urination is the clear pathway governed by qi, while the large intestine is the turbid pathway governed by blood. For those with blood deficiency, dry stools are particularly common; therefore, Siwu Tang combined with Maziren is the primary treatment. For blood dryness, add Taoren and Chuanjun; for qi dryness, add Xingren and Zhike; for wind dryness, add Zaogiao, Baizhi, and Fangfeng; for fire dryness, add Zhike, Houpu, Dahuang, and Mangxiao. The large intestine serves as the gatekeeper of the stomach, which is a dry earth. If the stomach has hard stools that cannot be expelled, the problem lies with the stomach rather than the large intestine. Symptoms include thirst, hot hands and feet, or delirium. In such cases, San Yi Chengqi Tang can be used to promote bowel movement, or Siwu Tang combined with Maziren, Zhike, Houpu, and Dahuang can be used to moisten and descend the qi.

If urination is frequent but unable to be controlled, while defecation is actually blocked, this is known as "spleen constraint." It means that the spleen's fluids leak out, leaving no moisture to lubricate the intestines. Zhang Zhongjing treated this condition with Pi Yue Wan. Danxi suggested clearing lung dryness; when the lungs are clear, urination is regulated, and the spleen receives adequate nourishment. Therefore, Qingzao Jiufei Tang is recommended for treatment.

The kidneys open to the two yin areas. If kidney yin is deficient and there is insufficient moisture to lubricate the intestines, Zuo Gui Yin combined with black sesame seeds and Rou Congrong is recommended.

The lungs and large intestine are interconnected. If the lungs leave residual heat in the large intestine, defecation will be difficult; if lung fluids do not moisturize the large intestine, defecation will also be difficult; if lung qi does not descend, defecation will be difficult. For residual heat in the lungs, Ren Shen Xiefei Tang is used; for lack of lung fluid, Qingzao Jiufei Tang is used; for lack of lung qi, Qingzao Jiufei Tang combined with Simo Tang, plus additional Xingren or a small amount of Tinglizi, is recommended. This should be considered in conjunction with the section on hematochezia.

In addition, there are cases of blood stasis causing blockage. This may occur after blood loss when residual blood remains unremoved; or after trauma when internal blood stasis accumulates and cannot be discharged, leading to constipation; or even when bowel movements are still infrequent despite occasional laxatives, with black stools, intermittent abdominal pain, thirst, fever, and a constricted pulse. In such cases, Tao Ren Chengqi Tang is recommended, or Shixiao San combined with Xingren, Taoren, Danggui, and Baishao.

[Commentary] This section discusses the pathogenesis and treatment of constipation. For blood-related constipation, it is often due to blood deficiency, so Siwu Tang combined with Maziren is recommended; for blood dryness, add Fangfeng and Zaogiao; for fire dryness, add Mangxiao; for blood stasis, use Tao Ren Chengqi Tang; if constipation leads to delirium, it indicates an issue with Yangming, so San Yi Chengqi Tang is recommended. Beyond these general treatments, constipation can also be related to the lungs, spleen, or kidneys. For lung heat left over in the large intestine, use Ren Shen Xiefei Tang or Qingzao Jiufei Tang. For spleen deficiency with strong stomach, known as "spleen constraint," use Pi Yue Wan. For kidney water deficiency causing intestinal dryness, use Zuo Gui Yin combined with sesame seeds and Rou Congrong.

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