In Treatise on Cold Damage, it is recorded: "When two yang meridians are concurrently affected, and the taiyang pattern has resolved, but tidal fever, sweating on the hands and feet, difficult defecation, and delirious speech appear, purgation will bring recovery." Although this "concurrent disease of two yang meridians" refers to the combined disease of yangming and taiyang, it reveals a core concept in traditional Chinese medicine: the same organ system can simultaneously manifest contradictory presentations of cold and heat intermingled, and disrupted ascending and descending functions. The alternating occurrence of constipation and diarrhea is precisely a typical manifestation of this "concurrent disease" way of thinking—seemingly contradictory symptoms actually point to the same core pathogenesis: disordered qi movement and imbalance of yin and yang. Clinically, such individuals are not few, yet the constitutional differences behind their conditions vary enormously.
Constitution Comparison Matrix: Why the Same Problem Requires Different Approaches
Constitution A: Liver Qi Stagnation with Spleen Deficiency Pattern—Qi Movement Blocked, Ascending and Descending Functions Disrupted
The liver governs free coursing and discharge, while the spleen governs transformation and transportation. When liver qi becomes stagnant and attacks the spleen transversely, the spleen's qi lacks the strength to raise the clear, causing water and dampness to pour downward as diarrhea; when liver qi fails to course freely and qi movement is obstructed, intestinal transmission becomes impaired, leading to dry, bound stool as constipation. Such individuals often present with distension and fullness in the chest and hypochondrium, worsening of symptoms during emotional fluctuations, and frequent belching. The core contradiction lies in "qi," rather than simple "deficiency" or "excess." Essential Prescriptions of the Golden Cabinet states: "When seeing liver disease, know that it will transmit to the spleen; one should first fortify the spleen." This suggests that treatment should prioritize coursing liver qi and regulating qi, while simultaneously fortifying the spleen and transforming dampness. Clinically, this constitution is commonly seen in individuals under long-term stress with irregular daily routines, and their constipation typically presents with the characteristic of "dry first, then loose" or "difficult defecation."
Acupoints related to the liver qi stagnation with spleen deficiency constitution include Taichong and Zusanli. Taichong, also known as Dachong, belongs to the Foot Jueyin Liver Meridian and is the shu-stream point and yuan-source point of the liver meridian. It is located on the dorsum of the foot, between the first and second metatarsal bones, in the depression anterior to the junction of the metatarsal bases. The Spiritual Pivot states: "When the five zang organs have disease, one should select from the twelve yuan-source points." As the yuan-source point of the liver meridian, Taichong is the representative surface location of the liver's qi coursing and discharge function. Zusanli, also known as Xialing and Sanli, belongs to the Foot Yangming Stomach Meridian and is the he-sea point of the stomach meridian and the lower he-sea point of the stomach. It is located on the anterior-lateral aspect of the lower leg, 3 cun below Dubi, one finger-breadth from the anterior crest of the tibia. These two points—one for the liver and one for the stomach—together embody the TCM understanding of "treating liver and spleen together."
Constitution B: Spleen-Stomach Deficiency Cold Pattern—Middle Burner Deficient and Cold, Transformation and Transportation Lacking Power
Unlike the liver stagnation type, those with spleen-stomach deficiency cold present with a preference for warmth and pressure on the abdomen, worsening of diarrhea after consuming cold or raw foods, and stool that is sometimes dry and sometimes loose—but when dry, it is mostly "deficiency constipation"—weak defecation effort, not dry bound stool. The root lies in insufficient spleen yang, with cold-dampness stagnating internally. Huangdi Neijing points out: "When central qi is insufficient, urination and defecation will change accordingly." When middle burner yang qi is weak, it can neither steam and transform water and grains, nor has the power to propel waste, hence the alternating constipation and diarrhea. Such individuals often have cold limbs, fatigue and lack of strength, a pale and swollen tongue with white, slippery coating. Clinically, it must be noted that if this constitution is mistakenly treated with bitter-cold purgative agents, it will further damage yang qi and worsen diarrhea.
For the spleen-stomach deficiency cold constitution, one may consider the concept of the Zhongwan acupoint. Zhongwan, also known as Taicang and Weiwuan, belongs to the Ren Mai (Conception Vessel) and is the mu-front point of the stomach and the meeting point of the fu organs. It is located on the upper abdomen, on the anterior midline, 4 cun above the umbilicus. The Classic of Difficult Issues states "the fu organs meet at Taicang," where Taicang refers to Zhongwan—a specific location where the qi of the zang-fu organs converges on the chest and abdomen, often used to understand the state of middle burner deficiency cold and impaired transformation and transportation.
Constitution C: Dampness-Heat Accumulation Pattern—Intestinal Fu Heat Stagnation, Clear and Turbid Not Separated
The dampness-heat constitution presents a completely different picture. When dampness-heat obstructs the middle burner, clear yang fails to ascend, causing diarrhea; turbid yin fails to descend, causing constipation. The constipation typically manifests as sticky, incomplete defecation with a sensation of incompleteness; diarrhea presents with "tenesmus"—a feeling of urgency and heaviness—with burning heat at the anus after defecation. Such individuals often have bitter taste in the mouth, bad breath, dark yellow urine, and a red tongue with yellow, greasy coating. The key lies in the adhesive state of "dampness" and "heat"—clearing heat alone will not remove dampness, and transforming dampness alone will intensify heat. Clinically, this constitution is relatively common among those who long-term consume rich, greasy, sweet foods and excessive alcohol, and symptoms often worsen in summer or after eating spicy foods.
For the dampness-heat accumulation constitution, one may learn about Yinlingquan and Neiting. Yinlingquan belongs to the Foot Taiyin Spleen Meridian and is the he-sea point of the spleen meridian. It is located on the medial aspect of the lower leg, in the depression between the lower border of the medial condyle of the tibia and the medial border of the tibia. Neiting belongs to the Foot Yangming Stomach Meridian and is the ying-spring point of the stomach meridian. It is located on the dorsum of the foot, between the 2nd and 3rd toes, in the web margin posterior to the red-white skin junction. The Classic of Difficult Issues states "ying-spring points govern body heat," and Neiting as a ying-spring point connects with the concept of intestinal fu heat stagnation; Yinlingquan is an important acupoint on the spleen meridian for regulating water-dampness transformation and transportation.
Contrast and Differentiation: The Clinical Logic of Treating the Same Disease with Different Methods
The core difference among the three constitutions lies in the attribution of "cold, heat, deficiency, and excess." The liver stagnation type belongs to qi stagnation, emphasizing qi regulation; the deficiency cold type belongs to yang deficiency, emphasizing warming and tonification; the dampness-heat type belongs to pathogenic excess, emphasizing clearing and transforming. Why does the same problem require different approaches? Because TCM treats not the symptom of "alternating constipation and diarrhea," but the "pattern" that produces the symptoms. Applying warming and tonifying agents such as ginseng and astragalus to a dampness-heat constitution is like adding fuel to fire; applying purgative methods such as rhubarb and mirabilite to a deficiency cold constitution is like adding frost to snow. Clinically, one must first distinguish whether "constipation" or "diarrhea" predominates, as the treatment directions differ: if constipation precedes diarrhea, it is mostly treated from qi stagnation and heat binding; if diarrhea precedes constipation, it is mostly approached from deficiency cold and dampness obstruction. If some individuals simultaneously present with emaciation, night sweats, and five-center heat, it may belong to the coexistence of yin deficiency with intestinal dryness and spleen deficiency with impaired transportation, and simple purgation or astringing is not appropriate—comprehensive pattern differentiation by a licensed TCM practitioner is required.
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Frequently Asked Questions
Q1: Is alternating constipation and diarrhea the same as irritable bowel syndrome?
TCM's pattern differentiation system differs from Western medicine's disease diagnosis. Irritable bowel syndrome can correspond to multiple TCM patterns such as liver qi stagnation with spleen deficiency and spleen-stomach deficiency cold, but not all cases of alternating constipation and diarrhea are equivalent to this disease. The two overlap but are not identical, and judgment requires combining specific symptoms and signs.
Q2: Why does eating bananas relieve constipation in some people but worsen diarrhea in others?
Bananas are cold in nature and can help with dampness-heat constipation to some extent, but those with spleen-stomach deficiency cold may have their yang qi damaged after eating them, leading to worsened diarrhea. This precisely reflects the constitutional difference of "same substance, different effects"—the same food has completely different impacts on different constitutions.
Q3: For long-term alternating constipation and diarrhea, is a colonoscopy needed first?
If warning signs such as blood in the stool, weight loss, or progressively worsening abdominal pain are present, it is recommended to undergo relevant examinations at a licensed medical institution to rule out organic disease. TCM treatment should be conducted on the basis of a clear diagnosis.
Q4: Why do some people use warming and tonifying methods while others use heat-clearing methods for the same problem?
This is the manifestation of TCM's "treating the same disease with different methods." When causes and pathogenesis differ, treatment methods naturally differ. The key lies in distinguishing cold, heat, deficiency, and excess, rather than the symptoms themselves. Clinically, licensed TCM practitioners make comprehensive judgments through tongue and pulse diagnosis, abdominal diagnosis, and other assessments to avoid mistreatment.