Treating Constipation by Excess and Deficiency Patterns

Constipation must not be treated indiscriminately with laxatives. Patients are divided into excess-pattern and deficiency-pattern: excess patients may be purged, while deficiency patients should be supplemented. There is no supplementation method for excess constipation, and no purging method for deficiency constipation; when excess and deficiency are mixed, supplementation and purging must be combined.

In excess constipation the abdomen is hard and full, caused by dry, bound stool; the various Chengqi Decoctions (Decoctions to Order the Qi) are appropriate. In deficiency constipation the abdomen is soft, caused by insufficiency of central qi; one should supplement the spleen and stomach and raise central qi—Buzhong Yiqi Wan and Guipi Wan are very effective. When both are present—the patient is deficient but the abdomen is full and bound—Xin Jia Huanglong Tang addresses both supporting the righteous and purging, and is used appropriately.

Abdominal palpation is essential in constipation; the key is to observe whether the abdomen is hard and resistant. Applying purely supplementary formulas to a hard, resistant abdomen leaves the pathogen with no way out. Applying purging formulas to a soft abdomen commits the error of making the deficient more deficient: the patient's central qi will sink further, and stool will not pass at all. In chronic illness, even if the abdomen feels full and hard, when deficiency signs are complete, neither pure purging nor pure supplementation will do; only combined attack and supplementation is suitable.

I once treated a constipation patient who had developed sinking of central qi after chemotherapy: the abdomen was soft, and there had been no bowel movement for many days. Doctors at Xiangya Hospital gave laxatives to no effect. On inquiry I found the abdomen soft and the patient too weak even to pass gas—this was qi deficiency with insufficient force to defecate. I advised Guipi Wan together with Buzhong Yiqi Wan; within twelve hours the bowels moved. Thus, laxatives are not always necessary in treating constipation.