constipation

Constipation, known in Traditional Chinese Medicine as 便秘 (biàn bì), is a commonly experienced digestive ailment characterized by infrequent passage of stools, hardness of stools, or a sense of incompleteness when having a bowel movement.

Its causes are numerous, ranging from lack of exercise or fibre, to certain medications, to changes in lifestyle, dehydration, IBS, and post-surgical complications. Psychogenic factors can also play a causal role.

Whatever the cause, in chronic constipation the large intestine’s functions of storage, transportation, and evacuation of stool have become compromised, and bowel movements have become difficult, unsatisfactory, or too infrequent.

Traditional Chinese Medicine’s understanding of the physiology and function of the large intestine is very similar to the Western understanding, and it views a normal bowel movement schedule as involving the passing of at least one unforced stool, every one to two days. Constipation can manifest according to the following TCM syndrome patterns:

Constipation due to Heat

This type of constipation is caused by an accumulation of heat in the intestines that causes dryness of the intestines and the stool. The patient feels the need to have a bowel movement, but passage is strained, and the stool is hard, dry, and like pellets.

The heat in question can arise from diet and lifestyle, as in the excessive consumption of alcohol, and/or spicy foods which damage the body fluids understood by TCM to moisten the large intestine.

The heat can also come from a constitution of excess yang, or from a febrile disease, both of which damage body fluids and lead to an inability of the body to adequately moisten the large intestine.

In TCM there is also an understanding of a connection between the Lung and Large Intestine, through which dryness and/or heat in the Lung can affect the Large Intestine, again leading to insufficient moisture for the easy passage of stool.

This syndrome pattern is characterized by bowel movements every few days. Urination is scant and dark, the complexion is reddish, there is thirst, with possible foul breath and fever. Abdominal pain and distension are also common.
The tongue is red with a yellow coat, and the pulse is rapid.

Acupuncture for constipation due to heat involves point prescriptions that act to clear the heat, moisten the intestine, and promote bowel movements.
Dietary and lifestyle advice are also an important aspect of treatment.

Constipation due to Qi stagnation

‘Qi’ is a very complex concept, so we’ll be limiting its meaning to the current context. One of the functions of qi in its circulation throughout the body is to distribute body fluids, which serve to moisten certain parts of the body, including the Large Intestine.

Qi can be made to stagnate in a number of ways, including lack of adequate physical exercise, and excessive stress or anxiety.
When qi stagnation occurs for one of these reasons, it can cause constipation by disrupting the distribution of body fluids to the Large Intestine, resulting in intestinal dryness.

Additionally, the qi of the Large Intestine itself, viewed as its peristaltic function, can also stagnate, making the actual pushing of the stool difficult.
In this syndrome pattern there is an urgency to defecate which is accompanied by difficulty in passing the stool.

There can be belching or chest or costal region tightness, poor appetite, and abdominal distension and pain.

The tongue is normal colour with a thin coat, and the pulse is wiry.
Acupuncture for constipation due to qi stagnation involves point prescriptions that act to promote qi circulation and eliminate stagnation and promote bowel movements.

Constipation due to Qi Deficiency

The main feature of this pattern of constipation is weakness on the part of the patient. The stools in this case are usually not particularly hard or dry, but the patient lacks the energy necessary to push the stool through the intestines.
There is a feeling of urgency, but the effort necessary to produce a bowel movement leads to shortness of breath afterwards, possibly accompanied by sweating.

As this syndrome pattern is characterized by weakness, the patient is generally fatigued, with a pale complexion and tongue, and a weak pulse.
Acupuncture for constipation owing to qi deficiency involves point prescriptions that tonify, or strengthen the qi, and moisten the intestines to promote bowel movements.

Constipation due to Yang Deficiency

As a concept in this context, yang involves the warming, active function of the body. It declines as we age.

In terms of constipation, the body’s yang must be adequate enough to propel the stool through the intestine. It must also be adequate to warm the intestine and prevent it from becoming cold and constricting, which can cause intestinal blockage. Further, yang plays a major role in fluid metabolism. Insufficient yang can cause insufficient transformation and distribution of the fluids necessary to lubricate the intestines. In the case of yang deficiency these fluids are lost as either excessive urination or as edema in the tissues.

This pattern is present in elderly populations, whose yang has naturally declined with age.

In this type of constipation, the stool isn’t necessarily dry, but can rather even be moist, or loose. Stools are difficult to pass, and leave the patient fatigued afterwards.

Other aspects of this syndrome pattern include copious, clear urination, a pale complexion, cold extremities, or a general intolerance of cold, and an achey low back and knees.

The tongue is pale with a white coat, and the pulse is slow or deep.
Acupuncture for constipation of this type consists of point prescriptions to warm and tonify the yang, improve fluid metabolism, and promote bowel movements.
Treatment may involve the use of moxibustion, which acts to strengthen the yang.

Constipation due to Yin Deficiency

Contrary to yang deficiency outlined above, constipation can also be caused by a deficiency of yin, which can be understood as the that which is responsible for the cooling, moistening, and nourishing of the body.

Like yang, yin naturally declines with age. Yin can also be damaged by febrile disease, inadequate rest over time, drug use, and a poor diet, or a diet of an excessively hot nature.

As with the other types of constipation, Yin deficiency results in dryness of the intestine.

Yin deficiency constipation features small dry stools often characterized as “rabbit droppings,” which are difficult to pass.

Other symptoms include thirst and general dryness, often of the skin, hair, eyes and nails, as well as possible sensations of heat in the palms and soles, night sweats, facial flushing, dizziness or tinnitus, and sore lower back and knees.
The tongue is red and dry, often with cracks and the pulse has a thin and rapid character.

Acupuncture for this type of constipation involves point selections to nourish the yin and body fluids, moisten the intestines, and promote bowel movements.