Jichuan Jian and Huangqi Tang for Deficiency-Consumption-Type Constipation
Elderly people and chronic patients often develop habitual constipation, which lasts a long time, recurs repeatedly, and lingers hard to heal. For such constipated patients, using strong laxatives is inappropriate. Treating such patients must balance supplementing deficiency with purgation; when using laxatives, mild laxatives should be chosen.
The Ming Dynasty famous physician Zhang Jingyue, in his Jingyue Quanshu (Complete Works of Jingyue), has a formula called Jichuan Jian suitable for treating this kind of constipation. Jichuan Jian consists of Danggui (angelica), Niuxi (achyranthes), Roucongrong (cistanche), Zexie (alisma), Shengma (cimicifuga), and Zhiqiao (immature bitter orange). It has the effects of warming the kidney and benefiting essence, moistening the intestines and freeing stool; it both relieves constipation and supplements deficiency, and is a common formula for constipation due to kidney deficiency with insufficient essence and qi and loss of intestinal conduction. Clinically it is used when there is bound stool, clear abundant urine, a pale tongue with deep pulse, and a weak body.
When I use Jichuan Jian, the common dosage is Danggui 15 g, Huainiuxi (Achyranthes) 6 g, Roucongrong 15–90 g, Zexie 6 g, Shengma 3 g, Zhiqiao 3 g. The dosage of Roucongrong can start from the minimum 15 g and be gradually increased; whether to increase depends on the laxative effect after taking it. If the laxative effect is poor, Roucongrong can be gradually increased to a larger dose.
In addition, the Taiping Huimin Heji Jufang (Taiping Holy Prescriptions for Universal Relief) records another formula, Huangqi Tang, consisting of raw Huangqi (astragalus), Chenpi (tangerine peel), Huomaren (cannabis seed), and white honey. The common clinical dose is raw Huangqi 30 g, Chenpi 15 g, Huomaren 30 g, white honey 10 g. When I use this formula, I also often add raw Baizhu (atractylodes) 30–60 g for a better laxative effect.
Huangqi Tang has the effect of boosting qi and moistening the intestines, mainly used for qi-deficiency constipation. In such patients the stool is not dry, but when going to the toilet they must strain hard to defecate; after defecation they are weak all over and prone to spontaneous sweating. The patient's complexion is often not ruddy, but pale or dull, with little color. Huangqi Tang works well for post-cerebral-infarction sequela patients and for cancer patients with constipation after surgery, radiotherapy, or chemotherapy.
These two formulas have many opportunities to be combined. Many patients have both qi-deficiency weakness and kidney-deficiency intestinal dryness, so the two can be used merged into one. Combined, they can even be used for intestinal obstruction in extremely weak patients.
The several Chengqi Tangs in the Shanghan Lun (Treatise on Cold Damage) all have rather drastic purgative strength; they can be used for acute constipation emergencies but are hard to use for chronic constipation, deficiency-consumption constipation, and habitual constipation. The herb Dahuang (rhubarb) has a purgative and laxative effect, but long-term use can itself cause habitual constipation. So rhubarb-containing laxatives can be used urgently in critical cases but should not be used routinely in lingering, chronic diseases. For the habitual constipation of chronic deficiency-consumption disease patients and the elderly, one must consider formulas like Jichuan Jian and Huangqi Tang and treat them slowly.
When prescribing clinically, one must distinguish carefully.