Constipation can affect up to 30% of the population and in the elderly the incidence can rise up to 70%. It can be an accompanying symptom asociated with other diseases like Parkinson’s disease, diabetes and diverticulitis. Certain medications can also cause constipation and in particular opioids can cause up to 90% of the people taking them bowel problems. Western medicine treatment usually involves suggesting more water, adding sufficient fibre to the diet or prescribing stool softeners. Abdominal pain and bloating can be associated with constipation.
In classical Chinese medicine diagnosis, there can be a number of causes of constipation or patterns of disharmony that constipation is associated with.
The liver and constipation
The liver is responsible for free flow of energy and is susceptible to energy blockage, in particular if emotional supression of anger is sustained. Long term irritability and resentment can block the liver energy causing constipation. Many women can also experience constipation and bloating before the menstrual cycle as a result of the liver energy becoming stagnant. One example of a formula that may be prescribed is xiao yao san.
Yin deficiency and constipation
When a person is in optimal health, there is a balance between yin and yang or fire and water in the body. If the yin becomes weak because of lifestyle such as a history of late nights or a history of fevers and sweating, the yin fluids become depleted leading to dryness. This type of yin deficiency dryness is not rectified by just drinking more water because the actual mechanism of water metabolism has been damaged. In fact, these type of patients often feel more discomfort when drinking excess water as it makes them bloated and sluggish. The herbal medicine approach is to use yin nourishing herbs and moistening herbs such as mai dong, a type of asparagus or black sesame seeds hei zi ma. These are just two examples of many herbs that may be part of a herbal prescription to treat constipation due to yin deficiency.
Yang deficiency and constipation
In yin deficiency there is heat and dryness causing constipation and in yang deficiency there is inability to push the stool as there is insufficent yang fire. An example of a herbal medicine that may be approcpriate here is rou cong yong.
Blood deficiency and constipation
Long term illness or a history bleeding disorders may lead to blood deficiency and cause constipation. Chinese herbs like dang gui and he shou wu could be selected as part of a formula in cases like this. Other acompanying symptoms such as tiredness, paleness, numbness and light headedness may also be present.
Different ways constipation could present itself
The effectiveness of Chinese herbs in the treatment of constipation comes down to the diagnosis and particular signs of the bowels can help ascertain which pattern of disharmony the person is fitting into. For example, stools which are dry often confirm yin deficiency and liver qi stagnation type constipation often complain they feel the urge to go to the toilet but when they go to have a movement, the urge stops. Yang deficient type constipation often have no sensation or urge to go at all for many days on end. Some people experience constipation where the stool resembles sheep droppings with small, hard and dry pieces. This is due to what is called in the classics knotted heat in the intestines and requires a stronger purging type herbal approach such as using the herb da huang.
Nine causes of constipation
In 2019, Will Maclean released the 2nd edition of Clinical Handbook of Internal Medicine which lists 9 causes of constipation. This is why it is wise to seek the services of a registered or licensed Traditional Chinese Medicine practitioner when looking at using Chinese herbs to treat constipation.
Long term use of laxatives
Many of the over the counter herbal laxatives can lead to dependency and spastic bowel. Chinese medicine looks at the cause of the problem and the treatment course once complete, will not require ongoing consumption of laxatives. In fact, Chinese medicine has documented how improper use of laxatives can cause other diseases which require different herbal formula to rectify.