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According to the Rome Foundation IV criteria, the global prevalence of constipation is approximately between 10% and 15%. If a broader self-report definition (such as "feeling constipated") is used, this figure can reach 16% to 33%. The risk for women is higher than for men, with a ratio of about 2:1 to 3:1. The prevalence increases with age, reaching 30% to 40% in the elderly population aged 65 and above, and can be as high as 50% to 70% among residents in long-term care facilities. The older one gets, the poorer the bowel motility becomes, making constipation more likely.

The medical definition of constipation is: having fewer than three bowel movements per week, or needing to strain during defecation with dry and hard stools. Some people may have daily bowel movements, and their stool may not be dry or hard, but they still have to wait a long time to pass stool, or they pass very little, feel incomplete evacuation, or have a sensation of residual stool — these cases are also considered constipation.

Constipation not only reduces an individual's quality of life but also increases medical expenses and societal costs, making it an important public health issue.

Modern Medical Findings

There are many causes of constipation, which modern medicine categorizes into the following types:

• Lifestyle and Dietary Factors: This is the most common cause, closely related to our daily habits.
  • Insufficient Fiber Intake: Dietary fiber increases stool bulk and softens stools. Inadequate intake (e.g., eating few vegetables, fruits, or whole grains) leads to hard, small-volume stools that are difficult to pass.
  • Insufficient Water Intake: When the body is dehydrated, the large intestine over-absorbs water from the stool, making it dry and hard.
  • Lack of Exercise: Prolonged sitting and little physical activity slow down intestinal peristalsis, causing stool to remain in the intestines for too long.
  • Ignoring the Urge to Defecate: Frequently holding in bowel movements due to busyness or inconvenience gradually reduces rectal sensitivity to stool, leading to a loss of the urge to defecate.
• Diseases and Physiological Conditions: Certain diseases or physiological states can affect bowel function.
  • Endocrine and Metabolic Diseases: Such as diabetes (causing neuropathy), hypothyroidism, hypercalcemia, etc.
  • Neurological Diseases: Such as Parkinson's disease, multiple sclerosis, stroke, spinal cord injuries, etc., which affect the nerves controlling the intestines.
  • Structural or Functional Abnormalities of the Intestines: Such as irritable bowel syndrome (constipation-predominant), intestinal obstruction, colorectal cancer, diverticulitis, etc.
  • Pregnancy: Hormonal changes and pressure from the enlarged uterus on the intestines easily lead to constipation.
• Psychological Factors: Depression, anxiety, excessive stress, etc., can also affect bowel function.
• Medication Side Effects: Such as opioid painkillers, certain antidepressants, antihistamines, certain blood pressure medications (like calcium channel blockers), antacids containing aluminum or calcium, iron supplements, etc.
• Aging: Older adults have a higher incidence of constipation due to decreased activity, muscle weakness, and taking multiple medications.

Cases where no clear organ, structural, or biochemical pathology is found, and which are not caused by specific medications, are collectively termed "functional constipation." This includes lifestyle and dietary factors (primary), intrinsic functional disorders of the intestines, and the influence of psychological factors. This article primarily discusses "functional constipation."

Western Medical Treatment

First-line Treatment: Basic Lifestyle Modifications

• Increase Dietary Fiber Intake: Increases stool bulk, retains water, making stools soft and easy to pass.
• Ensure Adequate Water Intake: Softens stools.
• Regular Exercise: Promotes intestinal peristalsis.
• Establish Good Bowel Habits: Trains the bowels to work at specific times.

Second-line Treatment: Medications. Considered when basic lifestyle modifications are ineffective.

• Bulk-forming Laxatives: Such as psyllium, oat bran, methylcellulose. Similar to dietary fiber, require ample water intake.
• Osmotic Laxatives: Such as milk of magnesia, polyethylene glycol, lactulose. Draw water into the intestines to soften stools.
• Stimulant Laxatives: Such as senna, bisacodyl. Directly stimulate the nerves in the intestinal wall to promote peristalsis.
• Other Prescription Medications: For stubborn constipation, including prokinetic agents, saline laxatives, etc.

Third-line Treatment: For severe, treatment-resistant constipation. Considered when medication therapy remains ineffective:

• Biofeedback Therapy: Primarily for difficulty defecating due to poor coordination of pelvic floor muscles; a type of "behavioral therapy."
• Surgery: The last resort.

The Holistic View of Traditional Chinese Medicine

In ancient TCM literature, there wasn't a specific term exactly equivalent to "constipation," but there were many disease names related to constipation, usually given different names based on symptoms and mechanisms, such as "difficult defecation," "non-free stool passage," "posterior discomfort," "inability to pass forward and backward," "spleen constraint," "yang knot," "yin knot," etc.

TCM does not view constipation as an independent disease, but rather as a "symptom" manifested after a systemic imbalance of yin, yang, qi, and blood. Treatment emphasizes "pattern differentiation and treatment," providing different treatments based on each individual's specific condition, rather than indiscriminately using laxatives. TCM believes the core mechanism of constipation lies in "abnormal conduction by the large intestine." Whether the large intestine functions normally is closely related to the functioning of other organs, most closely with:

• The Spleen and Stomach (Transportation and Transformation function): The Stomach governs receiving and ripening food and fluids; the Spleen governs transportation and transformation, distributing the essence of food and water throughout the body. If Spleen and Stomach function is weak and transformation is powerless, then the generation of qi and blood is insufficient, and the intestines lack propulsive force.
• The Lungs (Diffusion and Descending function): The Lungs and Large Intestine are exteriorly-interiorly related. The descending of Lung qi aids the transmitting function of the large intestine. If Lung qi is stagnant or weak, it affects the propulsive force of the large intestine; so-called "qi constipation" is often related to this.
• The Liver (Dredging and Dispersing function): The Liver governs dredging and dispersing, regulating the flow of qi throughout the body. If emotional distress or significant stress leads to Liver qi stagnation, it can cause stagnation of intestinal qi and obstructed conduction.
• The Kidneys (Govern the Two Lower Orifices): If Kidney yin is deficient, then the intestinal fluids are depleted, like "a riverbed lacking water," leading to dry, hard stools. If Kidney yang is deficient and declining, it's like "no fire under the pot," the intestines become cold, and propulsive force is lacking, leading to cold constipation.

TCM categorizes constipation into many patterns (i.e., a specific systemic pathological state). The following are common ones:

• Excess Heat Type: "Excess" means the function of the large intestine is hyperactive, absorbing too much water, leading to very dry, hard stools that are extremely difficult to pass, even accompanied by abdominal distension and pain, along with symptoms like a red face, body heat, dry mouth, bad breath, restlessness, or scanty dark urine. These patients may indulge in spicy, heating, dry foods, or consume few vegetables and little water, or have a naturally hot and dry constitution. Treatment focuses on reducing the hyperactivity and internal heat-dryness of the large intestine, promoting bowel movements. As the patient has no other deficiency conditions, it's acceptable to purge them.
• Qi Stagnation Type: Just like traffic lights regulate the flow of cars, in TCM, qi stagnation is a dysfunction of the body's regulatory capacity, leading to functional stagnation. TCM recognizes that the gastrointestinal tract is also regulated by "Liver qi," part of which essentially corresponds to autonomic nervous system regulation. If Liver qi is stagnant and regulation is ineffective, gastrointestinal peristalsis becomes poor and slow, bowel movement frequency decreases, there's a desire to defecate but inability to pass, often accompanied by belching, or fullness in the chest and hypochondrium, abdominal distension and pain. As stool stays too long and water is over-absorbed by the large intestine, it becomes dry and hard, leading to difficulty defecating. This pattern is often seen in those who sit for long periods with little movement, have high life stress, or are prone to melancholy. Treatment aims to unblock the qi mechanism, disperse stagnation, and restore gastrointestinal regulation.
• Qi Deficiency Type: "Qi" is energy and motive force. "Qi deficiency" means insufficient intestinal motility, weak peristalsis. Although there is an urge to defecate, one squats for a long time without being able to pass stool. Due to weak digestion, food ferments and produces gas in the intestines, leading to abdominal distension and frequent flatulence. Large intestine absorption becomes poor, so the stool is not particularly hard. These patients often have signs of low energy, Heart and Lung qi deficiency, manifesting as easy fatigue, reluctance to speak, and becoming short of breath or tired with slight exertion. Treatment focuses on "tonifying qi," i.e., enhancing the energy and motive force of the digestive tract.
• Yang Deficiency Type: A progression from qi deficiency is "yang deficiency," meaning gastrointestinal function has weakened to an extreme, even to the point of losing warmth. In addition to qi deficiency symptoms, one may see cold hands and feet, fear of cold, frequent urination, cold pain in the abdomen, stools containing undigested food, soreness and coldness in the lower back and knees. Treatment aims to invigorate gastrointestinal function while providing warmth. This is the unique TCM concept of "warming yang," using warm-natured Chinese medicinals.
• Blood Deficiency Type: "Blood" brings oxygen, nutrients, and heat to tissues. Blood deficiency means the intestines lack the moistening effects of oxygen and nutrients, peristalsis worsens, and the intestines become dry. Often, there is no bowel movement for several days, stools are dry and hard, difficult to pass, accompanied by a pale complexion, susceptibility to palpitations, dizziness, or fatigue, pale lips and nails. Qi and blood are two sides of the same coin, mutually supportive. Blood deficient patients are usually also qi deficient. Treatment focuses on tonifying blood while also tonifying qi.
• Yin Deficiency Type: "Yin" is a general term for the various nourishing, sustaining, and tissue-building substances within the body. "Yin deficiency" leads to dry intestines, dry, hard stools, and difficulty with peristalsis, often accompanied by dry mouth and throat, emaciation, dizziness, tinnitus, soreness and weakness in the lower back and knees, even heat in the palms and soles, flushed cheeks, restlessness, insomnia, tidal fever, or night sweats. Treatment primarily focuses on increasing the body's yin fluids. TCM's yin-tonifying medicinals are all natural medicinal materials that can provide the body with multifaceted refined nutrients.

Various deficiency-type constipations are often seen in the elderly, those with prolonged illness and weak constitution, or those who are overworked. Blood deficiency and yin deficiency both result from daily excessive consumption or insufficient nutrient intake. For example, overly frequent menstruation or heavy menstrual flow, postpartum bleeding, major bleeding from trauma or surgery, long-term occult bleeding from the intestines, urinary system, or hemorrhoids, or weak digestion and absorption function, or poor hematopoietic function, can all lead to blood deficiency. Chronic stress, staying up late using the brain, excessive sexual activity, or the chronic consumption of prolonged illness can all deplete yin fluids, leading to yin deficiency. Frequently eating icy foods and drinks, or old age and chronic illness, can also easily lead to yang deficiency, or even deficiency of both yin and yang.

TCM treatment is based on the patient's current systemic state: reducing excess and tonifying deficiency. It is refined, treats the root cause, and is effective. Not only does it cure constipation, but the body's overall condition also improves significantly.

Constipation Caused by Intestinal Adhesions

This type of constipation is less frequently mentioned. It occurs because there are adhesions between parts of the intestines, affecting peristalsis — like scissors whose blades are glued together and cannot open and close easily. Patients often have a history of abdominal surgery or have suffered a heavy blow to the abdomen. The winding intestines become adhered together due to surgical blood stasis or injury, greatly affecting intestinal peristalsis. Conventional drug treatments are generally ineffective for this type of constipation.

In Western medicine, this constipation usually requires surgery. If surgery is not currently considered or the patient is too weak for surgery, unique TCM methods using medicinals that soften hard masses and dissipate nodules and medicinals that invigorate blood and resolve stasis can be used to dissolve the adhesions between the intestines, offering a chance for a cure without continued medication or surgery.

The author once encountered a case of a constipation patient with no history of surgery or trauma, but imaging confirmed intestinal adhesions. This patient was thin and weak in appearance, suffering from bloating and constipation daily. Because the patient was constitutionally deficient and could not withstand the dispersing and breaking nature of adhesion-resolving medicinals, the prescription also had to be assisted with qi and blood tonifying medicinals to protect the patient's vital qi. After several treatments, the patient's bloating and constipation finally showed significant improvement.

Acupoint Massage and Moxibustion

Acupoint massage is a very practical and effective method in TCM for treating and alleviating constipation, suitable for home self-care. Its principle lies in regulating qi movement, promoting intestinal peristalsis, nourishing yin and moistening dryness by stimulating specific acupoints, thereby improving constipation.

The following introduces several commonly used acupoints for treating constipation and the massage methods:

Constipation Pattern	Selected Acupoints
Excess Heat Type	Zhongwan (CV12), Xiawan (CV10), Tianshu (ST25), Zusanli (ST36)
Qi Stagnation Type	Tianshu (ST25), Zusanli (ST36), Taichong (LR3)
Qi Deficiency Type	Tianshu (ST25), Zusanli (ST36), Hegu (LI4)
Blood Deficiency Type	Tianshu (ST25), Zusanli (ST36), Sanyinjiao (SP6)
Yin Deficiency Type	Tianshu (ST25), Fuliu (KI7), Sanyinjiao (SP6)
Yang Deficiency Type	Hegu (LI4), Taixi (KI3), Zusanli (ST36)

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

Acupoint Massage Method: Use a massage tool of moderate hardness or your own finger to massage the relevant acupoints in sequence. Press until a slight soreness is felt; do not use excessive force. If light touch causes pain, it indicates the point is injured; temporarily avoid pressing it.

Patients with Yang deficiency can use moxibustion on the acupoints. Apply moxa to one point at a time, moving to the next point when a burning sensation is felt. For mild deficiency-cold, moxa each point for about 10 minutes per round; for severe deficiency-cold, moxa for 15-20 minutes per round. If dry mouth and tongue occur, it indicates excessive moxa, causing "heatiness"; temporarily stop moxibustion.

Patients with Excess Heat or Yin Deficiency must not use moxibustion.

Daily Health Maintenance

• Massage the abdomen in a clockwise direction to help intestinal peristalsis.
• Consume an adequate amount of water daily (including from food and soup). The minimum daily water intake = individual body weight in kg × 30cc. For example, a person weighing 50kg needs at least 50×30cc=1500cc of water per day.
• Drink a cup of warm water immediately upon waking to help promote bowel movements.
• Get at least 7 hours of sleep per night. Staying up late can easily cause autonomic nervous system imbalance, leading to constipation.
• Exercise can stimulate gastrointestinal peristalsis and improve constipation, e.g., brisk walking daily.
• High-fiber foods (such as vegetables, germinated brown rice, oatmeal, legumes) can stimulate gastrointestinal peristalsis.
• A moderate amount of healthy fats (such as olive oil, nuts, avocado) can lubricate the intestines, aiding smooth bowel movements.
• Foods like peanuts, apples, pineapple, sweet potatoes, black fungus, kiwifruit, dragon fruit, and prune juice can also help with bowel movements.
• Foods like yogurt, kimchi, natto, and miso can increase beneficial gut bacteria and improve constipation. Consuming prebiotics, which are food for probiotics, such as onions, garlic, leeks, bananas, etc., can help good bacteria settle in.
• Avoid hot-dry, spicy, and other stimulating foods and drinks.
• Go to the bathroom when you feel the urge; don't hold it in. If you can't pass, don't strain excessively, to avoid hemorrhoids.

Summary

Traditional Chinese Medicine views constipation as a sign of systemic imbalance, closely related to dysfunction of the Zang-fu organs like the Spleen, Lungs, Liver, and Kidneys. Treatment is never simply about purging, but starts from the whole, focusing on restoring the body's overall balance and function. It is not just about "relieving constipation" but about "regulating the constitution." Through the comprehensive use of the four diagnostic methods (inspection, listening/smelling, inquiry, palpation) and following the principle of "pattern differentiation and treatment," TCM distinguishes between deficiency and excess in constipation, providing the most appropriate personalized treatment plan to fundamentally resolve constipation and prevent recurrence.