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Constipation is almost a national ailment. In the 2015 list of the top ten medications announced by Taiwan's National Health Insurance Administration, magnesium oxide, used for softening stools, was used more than 300 million times in one year. According to statistics, more than 50% of office workers in Taiwan have experienced constipation; among those over 60 years old, one in three suffers from long-term constipation. The older one gets, the worse the peristaltic function of the intestines becomes, making constipation more likely.

The medical definition of constipation is: having fewer than three bowel movements per week, or needing to strain and having hard, dry stools that are difficult to pass. Some people have daily bowel movements, and their stools are not hard or dry, but they take a long time to pass, or they pass only a small amount, feel incomplete, or have a residual sensation. The author believes these cases also count as constipation.

There are many causes of constipation, which can be roughly divided into two categories based on whether there are organic abnormalities in the intestines:

• Organic constipation: There is a structural abnormality or obstruction in the intestines, such as congenital elongated colon, or large intestine polyps, large intestine tumors, or abdominal tumors compressing the intestines.
• Functional constipation: There is no structural abnormality or obstruction in the intestines. Most cases of constipation fall into this category, such as aging, autonomic nervous system disorders, drug side effects, diabetes, hypothyroidism, etc.

This article only discusses functional constipation. Traditional Chinese Medicine (TCM) divides constipation into many patterns (i.e., certain systemic disease states), with the following being common:

• Excess heat pattern: "Excess" represents an overactive large intestine function, absorbing too much water, leading to hard, dry stools that are very difficult to pass, and even abdominal distension and pain. Such patients may indulge in spicy, hot, and dry foods, or consume little vegetables and water, or have an innate constitution of dryness-heat. Treatment focuses on reducing the hyperactivity and dryness-heat of the large intestine, promoting bowel movements. Since these patients have no other deficiencies, it is acceptable to let them have a thorough evacuation.
• Qi stagnation pattern: Just as traffic signals regulate the flow of cars, in TCM, qi stagnation means the body's regulatory ability is impaired, leading to functional stagnation. TCM has found that the gastrointestinal tract is also regulated by "liver qi," part of which is the regulation of the autonomic nervous system. If liver qi is stagnant and regulation is poor, intestinal peristalsis will worsen, the large intestine's peristalsis will slow down, and the frequency of bowel movements will decrease. Stools that stay too long and have their water excessively absorbed by the large intestine will become dry and hard, making bowel movements difficult. This type is often seen in those who sit for long periods, have high life stress, or are prone to depression. Treatment focuses on promoting qi movement, dispelling stagnation, and restoring gastrointestinal regulation.
• Qi deficiency pattern: "Qi" is energy and power. "Qi deficiency" means insufficient intestinal motility, weak peristalsis. Although there is an urge to defecate, squatting for a long time results in no bowel movement. Due to weak digestion, food stays in the intestines for a long time, fermenting and producing gas, leading to abdominal distension and fullness, excessive flatulence, and poor absorption in the large intestine, so stools are not particularly hard. Such patients often show signs of low energy and heart-lung qi deficiency, such as easy fatigue, reluctance to speak, and getting breathless or tired with slight exertion. Treatment focuses on "tonifying qi," that is, enhancing the energy and motility of the digestive tract.
• Yang deficiency pattern: Qi deficiency can progress to "yang deficiency," indicating that gastrointestinal function has weakened to an extreme, even to the point of hypothermia. In addition to qi deficiency symptoms, there may be cold hands and feet, fear of cold, frequent urination, cold abdominal pain, and stools containing undigested food. Treatment aims to boost gastrointestinal function while providing warmth, a unique concept in TCM known as "warming yang," using warm and hot medicinals.
• Blood deficiency pattern: "Blood" provides oxygen, nutrients, and heat energy to tissues. In cases of blood deficiency, the intestines lack the nourishment of oxygen and nutrients, leading to poor peristalsis and dryness in the intestines. This often results in difficulty in bowel movements for several days, with dry and hard stools that are hard to pass. It is also accompanied by a pale complexion, susceptibility to palpitations, dizziness, or fatigue. Qi and blood are two sides of the same coin, complementing each other. Patients with blood deficiency usually also have qi deficiency. Treatment focuses on tonifying blood while also tonifying qi.
• Yin deficiency pattern: "Yin" is a general term for various nutrients in the human body used for nourishment, maintenance, and tissue construction. "Yin deficiency" can lead to dry intestines, hard stools, and difficulty in bowel movements, often accompanied by dry mouth, weight loss, dizziness, tinnitus, soreness and weakness in the lower back and knees, and even heat in the palms and soles, flushed cheeks, irritability, insomnia, hot flashes, or night sweats. Treatment mainly focuses on replenishing the body's yin fluids, and TCM's yin tonic are natural medicinal materials that can provide the body with various subtle nutrients.

Various deficiency-pattern constipation is commonly seen in the elderly, those with chronic illness and weak constitution, or those who are overworked. Blood deficiency and yin deficiency are both caused by daily excessive consumption or insufficient nutrient intake, such as too frequent menstruation or excessive menstrual blood, postpartum, trauma, or major bleeding during surgery, long-term fistula disease in the intestines, urinary system, or hemorrhoids, or weak digestive and absorption functions, or poor hematopoietic function, all of which can lead to blood deficiency; while long-term stress, staying up late using the brain, excessive sexual activity, or chronic consumption from long-term illness can all deplete yin fluids, leading to yin deficiency; frequently eating cold foods and drinks, or old age and chronic illness, can also easily lead to yang deficiency, and even yin-yang deficiency.

Modern medicine treats constipation without distinguishing the patient's cold, heat, deficiency, excess, etc., constitution, or the macroscopic state of the system, and uniformly gives laxatives, stool softeners, or enemas, and the dosage may increase over time, becoming less effective, and even worsening constipation.

TCM treatment is based on the patient's current system state, treating excess with purgation, and treating deficiency with tonification, which is more refined, fundamental, and effective than modern medicine, not only curing constipation but also significantly improving the body's condition.

Constipation caused by intestinal adhesions

This type of constipation is rarely mentioned because there are adhesions between the intestines that affect peristalsis, just like if the blade of scissors is glued, it is not easy to open and close. Patients often have a history of abdominal surgery or have suffered a heavy blow to the abdomen, and the curved intestines are stuck together due to static blood from surgery or injury, greatly affecting intestinal peristalsis. For this type of constipation, conventional drug treatments are not effective, and it is necessary to use the unique softening hardness and dissipating mass and invigorating blood and resolving stasis medicinals of TCM to dissolve the adhesions between the intestines, in order to truly cure it and no longer need to take medication.

The author once encountered a case of constipation patient with no history of surgery or trauma, but imaging confirmed intestinal adhesions. This patient was thin and weak in appearance, and suffered from bloating and constipation every day. Because the patient was physically weak and could not withstand the opening and breaking of softening hardness and dissipating mass drugs, the prescription also needed to be supplemented with tonifying qi and blood Chinese medicinals to protect the patient's healthy qi. After several treatments, the patient's bloating and constipation were significantly improved.

Acupoint Massage and Moxibustion

Constipation pattern	Selected acupoints
Excess heat pattern	Zhongwan (CV12), Xiawan (CV10), Tianshu (ST25), Zusanli (ST36)
Qi stagnation pattern	Tianshu (ST25), Zusanli (ST36), Taichong (LR3)
Qi deficiency pattern	Tianshu (ST25), Zusanli (ST36), Hegu (LI4)
Blood deficiency pattern	Tianshu (ST25), Zusanli (ST36), Sanyinjiao (SP6)
Yin deficiency pattern	Tianshu (ST25), Fuliu (KI7), Sanyinjiao (SP6)
Yang deficiency pattern	Hegu (LI4), Taixi (KI3), Zusanli (ST36)

Each treatment session: Press each acupoint for 3-5 seconds, release for 3-5 seconds, repeat for 3-5 minutes before moving to the next acupoint. Perform one session in the morning, noon, and evening.

Acupoint massage method: Use a massage stick of moderate hardness or your own fingers to massage the relevant acupoints in sequence. Press until you feel a slight soreness, but do not use excessive force. If you feel pain upon light touch, it indicates that the acupoint is injured, so avoid pressing it further.

Patients with yang deficiency can use moxibustion on the acupoints, treating one acupoint at a time. When you feel a burning sensation, move to the next acupoint. For mild cold deficiency, moxibustion lasts 10 minutes per session; for severe cold deficiency, 15-20 minutes per session. If you experience dry mouth and tongue, it indicates over-moxibustion and internal heat, so stop moxibustion temporarily.

Patients with excess heat or yin deficiency should not use moxibustion.

Other recommendations

• Ensure adequate daily water intake. The minimum daily water intake = body weight in kg × 30cc. For example, a person weighing 50kg should drink at least 50 × 30cc = 1500cc of water daily.
• Drinking a glass of water immediately after waking up helps with bowel movements.
• Sleep at least 7 hours daily. Staying up late can disrupt the autonomic nervous system, leading to constipation.
• Exercise stimulates gastrointestinal motility and can improve constipation, such as daily brisk walking.
• High-fiber foods can stimulate gastrointestinal motility, such as vegetables, germinated rice, oatmeal, and legumes.
• Foods like peanuts, apples, pears, sweet potatoes, and black fungus can also aid bowel movements.
• Foods like yogurt, kimchi, natto, and miso can increase beneficial gut bacteria and improve constipation.
• Avoid dry-heat and spicy foods.
• Do not hold in bowel movements when you feel the urge. Do not force it if you cannot defecate, to avoid hemorrhoids.