"Nine out of ten people suffer from constipation"—this folk saying is not without foundation. Modern epidemiological surveys show that the global prevalence of chronic constipation is approximately 10%–20%, with even higher proportions among middle-aged and elderly populations and sedentary office workers. Going several days without a bowel movement may appear on the surface to be intestinal "traffic congestion," but in Chinese medicine clinical practice, it is often a mirror reflecting deeper imbalances within the body. So where does constipation actually come from? Is it merely as simple as "excess internal heat"?
Tracing the Causes: Those Overlooked "Invisible Drivers"
Constipation never develops overnight. Long-term dietary preferences—such as a fondness for spicy and grilled foods, or excessive consumption of raw and cold fruits and vegetables—can disrupt the spleen and stomach's transportation and transformation functions. Pungent, dry, and heat-producing foods deplete body fluids, much like a pot without water in which rice grains naturally cannot be cooked; while cold and cooling foods are like throwing cold water on a stove, trapping yang qi and causing the intestines to lose their propulsive power for peristalsis. In addition, prolonged sitting with little movement and emotional disharmony (such as chronic anxiety or excessive worry) are also important triggers. Chinese medicine theory states that the liver governs free coursing; if liver qi becomes constrained, the movement of qi becomes obstructed, and the large intestine—the official of transportation—will also "go on strike." As these factors accumulate over time, going days without a bowel movement gradually becomes a habit.
Differentiating the Disease Location: Beyond the Intestines, Organs Are Interconnected
Many people assume that constipation is solely a problem of the large intestine, but in Chinese medicine clinical practice, one must probe deeper: where exactly is the disease located? The Huangdi Neijing states: "The large intestine is the official of transportation; transformation and elimination emerge from it." However, this "transportation" function does not operate in isolation. The lung and large intestine are interior-exteriorly related; only when lung qi descends normally can body fluids be sent down to the large intestine. The spleen governs transportation and transformation; if spleen qi is deficient, it lacks the power to push waste products forward. The kidney governs both urination and defecation; if kidney yang is insufficient, the intestines lose their warming influence—like frozen ground in winter, where horses and carriages struggle to pass. Therefore, going days without a bowel movement may have its root in the lung, the spleen, or the kidney, and not merely in the "laziness" of the intestines themselves.
In Chinese medicine meridian theory, the Tianshu acupoint is closely related to intestinal function. Tianshu, also known as Changxi or Gumen, is located on the abdomen, level with the center of the umbilicus, 2 cun lateral to the anterior midline. It belongs to the Foot Yangming Stomach Meridian and is the Front-Mu acupoint of the large intestine. Front-Mu acupoints are specific acupoints where the qi of the zang-fu organs converges on the chest and abdomen; therefore, Tianshu is often regarded as an important window for observing the state of large intestine qi movement. The Lingshu · Jiu Zhen Shi Er Yuan calls it the "source of the diaphragm," demonstrating its esteemed position in the minds of the ancients. In clinical pattern differentiation, physicians often observe whether there is distension, tenderness, or other abnormal reactions in the region of Tianshu to assist in determining whether large intestine transportation function is normal.
Differentiating the Nature of the Disease: Cold, Heat, Deficiency, and Excess Cannot Be Conflated
Clinically, one must first distinguish whether the constipation is predominantly "heat" or predominantly "deficiency," as the directions of regulation are entirely different. Heat-type constipation is commonly seen in those who chronically consume fried foods and stay up late, presenting with dry, pellet-like stools, accompanied by dry mouth, foul breath, a red face, restlessness, a red tongue with yellow, dry coating. Deficiency-type constipation, on the other hand, is commonly seen in the elderly, the weak, postpartum women, or those with chronic illness; there is an urge to defecate but straining is required, the stool may not be hard, yet there is always a feeling of insufficient strength to expel it, accompanied by shortness of breath, fatigue, a pale complexion, and a pale tongue with a thin coating. There is also cold-type constipation—in those with insufficient yang qi, intestinal peristalsis is slow, and although there is no bowel movement for days, there is no abdominal distension or discomfort; instead, there is aversion to cold and cold limbs. If one does not differentiate cold, heat, deficiency, and excess, and indiscriminately uses heat-clearing and fire-purging agents, it will instead aggravate the troubles of those with deficiency-cold.
Disease Progression: The Chain Reaction from "Obstruction" to "Disharmony"
If going days without a bowel movement is left unaddressed, how will the disease progress? In the early stages, it may only be qi movement obstruction and insufficient body fluids; waste products remain in the intestines for too long, water is repeatedly absorbed, and the stool becomes increasingly dry, forming a vicious cycle. If it persists over a long period, turbid qi may rise upward, potentially causing foul breath, acne, and irritability with insomnia; turbid qi pouring downward may induce hemorrhoids and anal fissures. More seriously, if fu-qi is obstructed, it will affect the ascending, descending, exiting, and entering of qi and blood, leading to systemic qi movement disorder. Clinically, some individuals with long-term constipation also experience dizziness, chest tightness, and poor appetite—this is no coincidence, but a typical manifestation of "turbid qi failing to descend, clear qi failing to ascend."
Prognosis and Care: The Right Direction Doubles the Result with Half the Effort
Since the roots of constipation are diverse, the approach to care naturally varies from person to person. For those with a heat tendency, one may appropriately increase intake of foods with moistening properties, such as pears, silver ear fungus, and honey—but note that these foods are not suitable for everyone; those with a deficiency-cold constitution who consume them excessively may instead worsen their discomfort. For those with qi stagnation or qi deficiency, simple "laxation" often yields minimal results; the key lies in regulating qi movement and supplementing middle qi. In Chinese medicine clinical practice, if some individuals simultaneously experience abdominal distension, belching, and emotional irritability, they may belong to the "liver qi stagnation" type, and should not simply use purgative agents, but rather focus on soothing the liver and resolving depression. The core of care lies in "conforming to one's constitution," rather than pursuing "a single purge to resolve everything."
Zusanli, also known as Xialing or Sanli, is one of the most renowned acupoints in Chinese medicine meridian theory. It is located on the anterior-lateral aspect of the lower leg, 3 cun below Dubi, one horizontal finger-breadth from the anterior crest of the tibia. It belongs to the Foot Yangming Stomach Meridian and is the He-Sea acupoint of the Stomach Meridian and the Lower He-Sea acupoint of the stomach. Since the spleen and stomach are the foundation of acquired constitution and the source of qi and blood generation, Zusanli is regarded in Chinese medicine theory as an important acupoint for regulating middle burner qi movement and restoring the spleen and stomach's transportation and transformation functions. The Lingshu records: "When pathogenic factors are in the spleen and stomach, then disease manifests as muscle pain... all are regulated at Zusanli," demonstrating its close association with spleen and stomach function. In the pattern differentiation of constipation, the deficiency or excess changes in the meridian where Zusanli is located also provide important reference information for physicians.
Daily Care: The Truth Revealed in Details
Beyond diet, adjusting bowel habits is equally important. Drinking a cup of warm water upon waking helps awaken the intestines; taking a moderate walk after meals can promote gastrointestinal peristalsis. However, note that these methods are helpful for functional constipation but are not applicable to all types. For example, for those with insufficient kidney yang and loss of intestinal warmth, drinking cold water upon waking may instead suppress yang qi and worsen constipation. Therefore, any care method must be determined by a licensed Chinese medicine practitioner based on pattern differentiation of the individual's constitution. In addition, emotional management cannot be overlooked—chronic anxiety and tension can inhibit gastrointestinal peristalsis, while relaxing body and mind through meditation, deep breathing, and other methods can to some extent assist in improving intestinal function.
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Frequently Asked Questions
1. Why does rhubarb work for some people's constipation but make it worse for others?
Rhubarb is a bitter, cold, purgative agent suitable for constipation with excess heat and accumulated stagnation. If used for deficiency-cold or qi-deficient constitutions, it not only fails to solve the problem but may also damage spleen and stomach yang qi, further weakening intestinal motility. Clinically, there are more than ten pattern types of constipation, and the direction of medication differs entirely for each.
2. Does drinking honey water long-term help with constipation?
Honey has a moistening and laxative effect, primarily suitable for those with insufficient body fluids and dry-intestine constipation. However, honey is neutral in nature with a sweet flavor; excessive consumption may promote dampness and impair the spleen. For those with weak spleen and stomach or internal exuberance of phlegm-dampness, it may instead worsen abdominal distension and sticky, incomplete bowel movements.
3. Why do some people who go days without a bowel movement need warming and tonification, while others need clearing and purging?
This reflects the Chinese medicine principle of "treating the same disease with different methods." For the same constipation, if it is due to insufficient yang qi and loss of intestinal warmth, then warming yang and unblocking the bowels is needed; if it is due to accumulated heat in the stomach and intestines with depletion of body fluids, then clearing heat and moistening the intestines is needed. Blindly following trends and using a particular method often leads to results contrary to one's wishes.
4. Are constipation and "excess internal heat" the same thing?
Not entirely equivalent. "Excess internal heat" is a colloquial term in Chinese medicine for heat-type patterns, and constipation is merely one possible manifestation. Clinically, constipation of the deficiency-cold, qi stagnation, and blood deficiency types does not accompany the typical symptoms of "excess internal heat" (such as dry mouth, sore throat, and yellow urine); instead, it may be accompanied by aversion to cold, fatigue, and a dull complexion.