Constipation is a symptom of a variety of common clinical diseases, which refers to a decrease in the frequency of bowel movements, a bowel movement every 3 to 4 days or longer without the use of laxatives, or a small and dry hard stool, some like sheep feces, and often a feeling of difficulty in defecation, or a combination of long defecation time, rectal distension, or a feeling of incomplete defecation. Population surveys in Beijing [1], Tianjin, Guangzhou [2], and Hangzhou show that the prevalence of constipation ranges from 3% to 17%, with more women than men and more elderly than young adults. With the trend of population aging, the change of diet structure and the influence of psychological and social factors, constipation has become an important disease affecting people’s quality of life. According to Chinese medicine, constipation is a condition in which the bowels are constipated, with prolonged defecation time or the desire to have a bowel movement that is awkward. Due to individual differences, each person’s situation is different, so we cannot take one bowel movement per day as the standard for bowel movement. The pathogenesis of constipation, Western medicine and Chinese medicine have their own interpretation of the pathogenesis of the disease, Western medicine mainly from the nerve, muscle, primary disease and other aspects to understand, while Chinese medicine that the cause of the disease is mainly responsible for the large intestine conduction malfunction, but also with the lung, spleen and kidney is very close relationship. The understanding of these two is as follows: 1. Western medical understanding: Regarding the mechanism of defecation, Western medicine believes that the food absorbed by the digestive tract is transformed into fecal masses, which form a sufficient volume of feces in the rectum to reach the rectum at a normal speed through the gastrointestinal tract in time to produce bowel movements and cause the defecation reflex; during defecation, the pelvic floor muscles coordinate their activities to complete defecation. This includes the participation of the nervous system and muscle activity (smooth muscle), and its lesions are three: (1) neurological lesions: mainly damage to the sacral nerve, lumbosacral spinal cord, and higher spinal cord causes a decrease in the tone of the colon and rectum, resulting in no bowel movement; intestinal neuropathy, such as congenital megacolon; or central diseases, such as various cerebral infarcts, cerebral hemorrhage, etc. (2) intestinal smooth muscle lesions: such as connective tissue disease, endocrine, metabolic diseases and other systemic diseases cause intestinal smooth muscle lesions; (3) intracavernous lesions of the gastrointestinal tract: mostly refers to intestinal obstruction caused by intracavernous lesions, through the obstruction and no stool, such as intestinal tumors, chronic intussusception, rectal prolapse, etc.; also due to drugs or psychosomatic disorders caused by constipation, such as the use of morphine preparations, or suffering from depression, anorexia nervosa, etc. Anorexia nervosa, etc. Currently, some special tests such as gastrointestinal transit test (GITT) or colonic transit test, barium defecography (BD) and anorectal manometry (ARM) are used to classify constipation into 3 types: slow transit constipation, outlet obstruction constipation and mixed constipation. Exit obstruction type constipation and mixed type constipation. 2, Chinese medicine understanding Chinese medicine will be called the disease constipation, according to the different etiology of symptoms have the following different names, “difficult stool”, “after unfavorable”, “spleen about”, “closed”, “constipation”. “closed”, “yin knot”, “constipation” and so on, “Ji Sheng Fang”, “the regimen is not proper, the three jiao qi is astringent, the transportation is not possible, so the congestion is knotted in the intestines and stomach Between, so into five secret of the problem. …… five secret, wind secret, gas secret, wet secret, cold secret, hot secret is also.” Now it is believed that constipation is mostly caused by heat accumulation in the large intestine, or gas stagnation, or cold condensation, or deficiency of yin and yang qi and blood, so it is mostly divided into four conditions: heat constipation, gas constipation, cold constipation, and false constipation. Jing Yue Quan Shu” clearly pointed out that constipation is the large intestine conduction malfunction, including the modern medicine of habitual constipation, the mechanism of the “source of diseases” cloud: “difficult to stool, by the five Tibet is not regulated, yin and Yang bias deficiency, said the three jiao is not and then cold and heat and knot. The stomach is the sea of water and grain, the essence of water and grain for the Rongwei, its dregs travel in the large intestine to get out also.” The whole process takes 24 to 48 hours, as in the Confucianism: “The stomach is the sea of water and grain, and it receives its new in order to change its old, one stool a day, which is also the normal degree.” There are four main pathogenic mechanisms: (1) Heat accumulation in the gastrointestinal tract: the accumulation of heat in the gastrointestinal tract due to alcohol and spices, or after a fever of typhoid fever, the residual heat stays, the fluid is depleted, and the intestinal tract is not moistened and develops. For example, Su Wen? Linglan Secret Discourse” cloud: “the large intestine, the conductor of the official, change out of it”, is the cause of the disease, is in the large intestine conduction malfunction. (2) qi stagnation: thoughts and emotions are not comfortable, sedentary and less active, resulting in qi stagnation, the loss of publicity and ventilation is not normal, conduction is out of order, the dregs within the stop, can not go down, and constipation. For example, “the cause of pulse treatment? The conclusion of constipation” cloud “anger is gas, thinking is gas knot, sorrow and thought, all the gas fries and depression, then gas congestion large intestine, and the stool is knotted.” (3) deficiency of qi, blood, yin and fluid: fatigue and internal injury, postpartum and old age deficiency, and into the fluid deficiency, qi deficiency, blood deficiency or deficiency of both qi and blood. Qi deficiency results in weakness of large intestine conduction. The cause and treatment of symptoms? The conclusion of constipation cloud: “If there is a deficiency of vital energy, lung gas can not reach down, then the large intestine can not transmit the order, and the stool is also knotted.” Blood deficiency and withered fluid can not nourish the large intestine, such as “Diagnosis Yu Collection? Not eating inconvenience” cloud: “people’s stool does not work, such as the river boat can not …… river water dried up, the boat can not travel. When into the blood to nourish the intestines of medicine.” Another example is the “source of miscellaneous diseases rhinoceros candle? Constipation source flow” cloud: “by the disease after the blood is not restored, by the postpartum to go too much blood and constipation”, and “the cause of the pulse treatment? The conclusion of constipation” cloud: “high yin depletion, blood dryness and exhaustion, then the stool is dry and constipated”. (4) Yin cold stagnation: Yang deficiency or senior body weakness, cold stagnation intestines, cold condensation blocking Yang, fluid does not work, intestinal lame, loss of transmission and constipation. For example, the “Diagnosis Yu Collection? Not eating inconvenience” cloud: “the river freezing, can not travel, ……, Yin knot of the disease, non-warm medicine can work.” Second, the combination of Chinese and Western medicine to explore the pathogenesis of constipation As mentioned above, Chinese and Western medicine from the etiology to the onset of the disease to give a systematic understanding of the disease, and there are dark and place. We believe that only by integrating the theories elaborated by Chinese and Western medicine can we help to better understand the nature of the disease, and ultimately eliminate the disease and solve the problem. In view of this, we have analyzed and organized the relevant theories of Chinese and Western medicine, the key to the treatment of this disease is to clarify the causes of constipation, the specific location of the disease, the treatment of the cause, the treatment of the disease to seek the root, can be described from the following three aspects. 1, fecal formation: Western medicine, the formation of feces, is the food in the digestive tract after digestion and absorption, the remaining residue of chyme transported to the colon, most of the water and electrolytes in the colon and then absorbed, and finally formed a fecal mass, transported to the sigmoid colon and rectum and excreted. Here, the same understanding in Chinese medicine is that after the food enters the stomach, is putrefied by the stomach and transported by the spleen, and its essence is absorbed, the remaining dregs become stool, mainly due to the putrefaction and transport function of the stomach and spleen, “stomach qi loses its descent” and “spleen loses its health and transport”, and the dregs stop inside and become constipation. Zhang Zhongjing, because of the inability of the stomach qi to move down, listed Cheng Qi Tang as a way to pass the stool, and “the spleen cannot move its fluids for the stomach” and listed the evidence of “spleen contract”, believing that the disease is related to cold, heat and qi stagnation. 2, fecal discharge: modern medicine will defecation process is very clear, specifically, the accumulation of fecal mass in the rectum swelling mechanical stimulation, when it exceeds a certain threshold causes the urge to stool impulse, impulse through the pelvic nerve, lumbosacral spinal defecation center, and then transmitted to the cerebral cortex. When the brain responds to this impulse, it produces a series of defecation agitation, including the pushing contraction of rectal smooth muscle, the relaxation of internal and external anal sphincter, and the contraction of pelvic floor muscle to raise the abdominal muscle and diaphragm, which increases the abdominal pressure, etc. Finally, the feces is expelled from the body. The action potential activity of the colon is enhanced after sleep and meal, the peristalsis of the colon increases, and the stool is pushed forward, which often causes the urge to defecate, and the urge to defecate of the participant is caused by the gastrocolic reflex. As the Suwen? The so-called “change” means that the water and grain essence through the gastric ripening, spleen transportation, and finally into the large intestine into feces, so the large intestine conduction failure can cause constipation. Because the lung and the large intestine are on top of each other, so the lung is not purified, the large intestine is out of balance, affecting the large intestine conduction function can also cause constipation. Tang Zonghai in the “essence of the medical scriptures? The official of the internal organs: “the large intestine can conduction, because it is the lung’s internal organs. Lung gas down to be able to conduct.” The stone room secret record? Stool dry knot” said: “constipation, people think that the large intestine dry, who knows is the lung dry, the lung is dry, the clean air can not go down in the large intestine.” Treatment can help the large intestine conduction by promoting the lowering of lung qi. 3, fecal control: this phase includes a complex process involving the pelvic nerve, lumbosacral spinal defecation center, cerebral cortex, rectal smooth muscle, anal sphincter, and pelvic floor muscles, abdominal muscles, colon peristalsis and so on. Ancestral medicine also attributed this part to the conduction function of the large intestine, which also includes the lung, as mentioned earlier, as well as some of the kidney function in it. If the kidney is the organ of water and fire, the division of yin and yang, such as kidney essence loss of solidity, can be caused by less fluid and intestinal dryness and eventually become kidney deficiency constipation, mostly treated with a formula such as Jichuan decoction, the kidney in the orifice for the two yin, the latter is the anus. The excretion of feces is the function of the large intestine to transfer the dregs, but it is also related to the qi of the kidney. If the kidney is deficient in yin, it can lead to constipation due to the drying up of intestinal fluids, and if the kidney is deficient in yang, it can lead to constipation or diarrhea due to yang deficiency. Treatment can be to nourish kidney qi, nourish kidney yin and strengthen kidney yang. Therefore, the identification and treatment of Chinese medicine is particularly important, only to identify the nature of the disease, especially the location of the disease, in order to make the appropriate time, or tonic, or diarrhea, or drop, or blood to achieve the success of the medicine to the work. Chinese medicine theory emphasizes the importance of diet and life conditioning, such as the “Thousand Gold Formula? The body is peaceful, only to be well nourished, do not take drugs. …… doctor, when the first understanding of the source of the disease, know the offense, to treat the food. If the food treatment does not heal, then order the medicine.” The first thing you need to do is to take medicine and always maintain a healthy and reasonable lifestyle, such as changing the habit of reading books and newspapers during bowel movements. It is not necessary to pursue regular defecation too much, so as not to increase the psychological burden, so that intestinal peristalsis is adversely disturbed. Example 1 Li Moumou, male, 46 years old, initially diagnosed on December 2, 2000, reported that the bowel movement is not smooth for more than 16 years, but the stool is not dry, and it needs to be laxed every day to be relieved with corkage, accompanied by a feeling of anal drop and increasing abdominal distension, sometimes abdominal pain, stomach pain, good appetite, abdominal distension after eating, accompanied by dizziness. The tongue was light yellow and greasy, with a light texture and a sunken pulse. Fiberoptic colonoscopy diagnosed chronic colitis and chronic proctitis. Treatment: Tonic Zhong Yi Qi Tang with reduction. The second diagnosis: on December 16, 2000, after taking the above 7 doses, the abdominal distension was reduced and the pain in the stomach and anus disappeared. But still dizziness and bowel irregularity, need to apply daily open cork, tongue coating light yellow greasy, tongue texture light, pulse sinking small. The patient’s symptoms of stomach pain, abdominal distension and anal drop improved, but the patient sat down and blamed, the stool was not dry and could not be relieved, so the method was to nourish blood and moisten the intestines. Angelica Sinensis 15g, Sheng Di 15g, Sheng Shou Wu 30g, Bai Shao 12g, Cistanches 20g, Danshen 30g, Chuanxiong 10g, Fu Ma Ren 15g, Tao Ren 10g, Fried Citrus aurantium 6g, Yu Li Ren 10g, Cyperus rotundus 10g, roasted Astragalus 20. Third diagnosis: December 23, 2000, said after taking the above stool is not dry, still defecation is not smooth, and abdominal distension, need to use the open plug, small abdominal left then there is a hard mass Feeling, pressure pain (+), sometimes have stomach distension, dizziness, facial fever, occasional nausea, yellow and greasy tongue coating, light tongue quality, pulse string small. Da Wu Rou Wan plus reduction. Almonds 10g, Scape Drabble 10g, Chen Pi 6g, Fried Citrus Aurantium 10g, Fire Hemp Seed 15g, Gua Pao Ren 15g, Prepared Rhubarb 10g, Cistanches 15g, White Peony 12g, Aster 15g, Chai Hu 10g, Sheng Ma 10g, Guang Mu Xiang 15g. In this formula, Daphne scoparia, Almond and Zingiber officinalis open lung qi and laxative. Cistanches nourish the kidney and moisten the bowel. Note: At the initial diagnosis, the patient was considered to have deficiency of spleen and stagnation of Qi, and Qi did not move downward, resulting in distention and fullness of the abdomen and stomach, which caused irregular bowel movement. The treatment is to tonify the spleen with tonics and strengthen the spleen, elevate the clear and lower the turbidity. At the second consultation, the patient’s symptoms of stomach pain, abdominal distension, and anal drop were improved. However, he was sitting on the deficient bowel, and the treatment was to nourish the blood and moisten the intestines in view of blood deficiency constipation. However, the effect was still unsatisfactory. The patient came to the clinic three months later with a cold, and all the symptoms were removed after two weeks of taking the three-consultation formula. Case 2 Ouyang Moumou, female, 70 years old, first diagnosed on March 15, 2001, with constipation for 10 years, dry stool, one line for 3-4 days, with numbness and weakness in the right leg, only able to walk continuously for 30 minutes, without abdominal pain and distension. The tongue is dark red, with a central yellowish greasy coating and a stringent pulse. Prescription: Radix Astragali 30g, Radix Angelicae Sinensis 12g, Radix Rehmanniae 15g, Radix Paeoniae Alba 12g, Radix Achyranthes Bidentatae 12g, Radix et Rhizoma Polygonatum 20g, Radix et Rhizoma Golden Hair 15g, Radix Cistanches 20g, Radix et Rhizoma Conjunctifolia 12g, Radix et Rhizoma Sanguisorba 15g, Radix et Rhizoma Firenze 15g, Radix Polygonatum Eucommiae 10g, Radix Peach kernel 10g. Unrelieved, no abdominal distension and abdominal pain, right leg numbness improved. Tongue and pulse as before. Prescription: roasted Astragalus membranaceus 30g, Angelica sinensis 15g, Radix et Rhizoma Polygonati 20g, Radix Paeoniae Alba 15g, Radix Achyranthes bidentatae 12g, Herba Cistanches 20g, Scapularia scabra 10g, Asteraceae 15g, Radix et Rhizoma rhizoma 10g, Radix et Rhizoma dulcis 6g, Radix et Rhizoma sangfroid 15g. The tendons and bones are not nourished, so the legs are numb and weak. The initial diagnosis was treated with the method of benefiting Qi and nourishing blood to strengthen the tendons and bones. The second consultation formula was supplemented with products for regulating lung qi, and the effect was obtained by taking into account the benefit of qi and blood. Case 3 Lu Moumou, female, 74 years old, was first seen on May 13, 2004: she reported irregular bowel movements for many years, a sensation of falling down in the anus, a sinking sensation in the waist and legs, even in the back, inflexibility in the two knee joints, pain in the left knee joint when it moves, stomach distension and pain, appetite, small amount of food, belching, red and painful tongue, dry mouth, disturbed heart, poor sleep, no obvious cough and asthma recently, but poor sputum production. Nocturnal urination is frequent. Previous gastroscopy for chronic superficial gastritis and allergic asthma. The tongue is thinly coated with white fur and the pulse is sunken and small. The treatment is to tonify the liver and kidney to strengthen the muscles and bones. 15 g of raw and ripe ground, 12 g of Dendrobium, 3 g of Phellodendron, 12 g of Chuan Niu Knee, 12 g of Eucommia, 12 g of Cuscuta, 15 g of Cistanches, 12 g of Medlar, 20 g of Radix et Rhizoma, 10 g of Bupleurum, 12 g of Radix et Rhizoma, and 10 g of Dioscorea. After two weeks of taking the above formula, the patient was diagnosed with dry stools, straining to defecate, stomach distension and pain after dinner, sinking waist, abdominal distension, tender tongue, thin and greasy tongue coating, and sunken and slippery pulse. He was treated with Tonic Zhong Yi Qi Tang and Wei Ling Xian Wan. Roasted Astragalus membranaceus 20g, Radix et Rhizoma Polygonati 15g, Fried Atractylodes Macrocephala 12g, Radix Angelicae Sinensis 15g, Radix Bupleurum Chinense 10g, Radix et Rhizoma Polygonati 6g, Herba Cistanche 20g, Radix Achyranthes Bidentatae 12g, Radix et Rhizoma Polygonati 30g, Radix Paeoniae Alba 20g, Radix Phellodendron Bidentatae 10g, Radix et Rhizoma Huangjing 30g, Radix et Rhizoma Polygonati 15g. The patient has been treated continuously in outpatient clinics for nearly six months and stopped taking the medicine for three months, and now has smooth bowel movements, insignificant changes in symptoms of lumbar heaviness, and more comfortable stomach. The patient is an elderly person with liver and kidney deficiency and tendon and bone failure, so the initial prescription was based on “Buju Ji? The formula is based on the Simmering Kidney Pill (Niubizi, Dioscorea, Cistanches, Cuscuta, Eucommia, Fenugreek, Tribulus terrestris, Boneset, and Cinnamon) as contained in the “Buju Ji”. It is used for treating liver and kidney damage and spleen, food and grain failure, benefiting essence and slowing down the middle, eliminating grain, and treating back pain and failure. His tongue is red, Dendrobium nourishes Yin and clears deficiency fire, and also strengthens tendons and bones. The patient still has symptoms of spleen deficiency, the spleen is the source of qi and blood biochemistry, the spleen is not healthy, the source of qi and blood is lacking, and the initial consultation focused on nourishing the liver and kidney, the patient still had constipation and stomach distension and pain after taking the medicine for two weeks. Therefore, at the second consultation, we identified the deficiency of both spleen and kidney, and the treatment was effective in strengthening the spleen, nourishing the kidney, nourishing blood and moistening dryness.