By DR BRUCE STAFFORD
29 November 2019
by DR BRUCE STAFFORD, 29 November 2019
A lot of patients present with constipation. Although not necessarily their primary complaint, moving their bowels will often help in their overall treatment. Moving bowels is usually easy enough in the short-term, but long-term use of bowel-moving herbs can make the bowel lazy and create a dependency.
I find that using herbs to retrain bowel movements in the short-term followed by teaching the patient long-term strategies to keep them moving without herbs is the best approach.
Clinically, I mainly see three pattern types:
- Dry-type – high pulses (Yin deficient), thin people. For these patients you must moisten the bowel to get the stool to move using Mai Zi Ren Wan plus additional Huo Ma Ren and Xing Ren as required.
- Wet-type – deep, spongy pulses in the guans (Damp/Damp-Heat). For these patients you must use bowel moving herbs that clear Damp. Yin Chen Hao Tang is ideal plus additional Da Huang and Mang Xiao as required (depending on the amount of Damp-Heat present). If the Stomach is weak then protect it using a warming formula or herbs. Note: if the patient’s blood pressure is high, they can handle Yin Chen Hao Tang or Da Huang at higher doses.
- Weak-type – weak pulses reflecting deficiency and a weak peristaltic action in the bowel. For these patients you must also tonics to move the bowel – Huang Qi and Dang Shen to boost peristalsis. Also add bowel movers like Huo Ma Ren, Xing Ren and Mang Xiao as required.
Note: if the pulses are really tight/wiry (the patient has a lot of stagnation/tension) you may also need to add herbs such as Chai Hu or a Chai Hu related formula to relieve constraint.
Long-term, I give the patient strategies to better manage their constipation on their own. This includes:
- Having them eat stewed apple each day (green apples are best). The fructose attracts water to their bowel to aid the passage of stool. If this doesn’t work then get them to add stewed rhubarb (to replace Da Huang).
- Introducing psyllium husk into their diet every day.
- Massaging their own abdomen in a clockwise direction for 1 minute in the morning and again at night.
As a last resort they could drink senna tea – powder is better than tea leaves if they can get it.
Dr Bruce Stafford (Chinese Medicine)
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