1.1 Qi and Blood Deficiency: Due to physical weakness from aging, insufficient spleen and stomach function, lack of qi and blood production, weak qi leads to powerless transmission in the large intestine, while blood deficiency causes depletion of body fluids, leading to dryness in the large intestine and resulting in constipation.
1.2 Yang Deficiency and Cold Aggregation: In old age, due to insufficient yang energy, internal cold is generated, stagnating in the intestines and stomach, causing yang energy not to circulate, body fluids not to flow, and the intestines to transmit powerlessly, forming constipation.
1.3 Yin Fluid Deficiency: In the elderly or those with long-term illness, or excessive use of purgative drugs, this can lead to significant loss of body fluids, drying up of the intestines, and difficulty in passing hard stools.
1.4 Qi Stagnation: In elderly people, frequent worry or prolonged sitting with little movement can cause qi stagnation, blockage of the bowels, retention of waste matter inside, and result in constipation.
1.5 Accumulated Heat in the Intestines and Stomach: With a constitutionally yang-excessive body, or excessive alcohol consumption, or overconsumption of spicy and rich foods, heat accumulates in the intestines and stomach, or after a feverish disease when residual heat has not completely dissipated, depleting body fluids, causing the intestines to lose their lubrication and resulting in constipation.
2 Treatment
2.1 Non-pharmacological Treatment: One should develop the habit of regular bowel movements, pay attention to dietary adjustments and physical exercise, especially for functional constipation. The diet should be rich in fiber and more water should be consumed.
2.2 Pharmacological Treatment: Clinically, constipation is divided into qi constipation, deficient constipation, cold constipation, and hot constipation. Deficient constipation is further divided into qi deficiency and blood deficiency types.
2.2.1 Qi-deficient Constipation: Characteristics include having the urge to defecate but lacking the strength to do so, stools are not hard, feeling tired and short of breath, tender tongue with thin coating, weak pulse. Medicinal herbs used include Astragalus, Poria, Hawthorn, Saussurea, Citrus medica, Citrus aurantium, Sesame seed, White Honey, etc.
2.2.2 Blood-deficient Constipation: Characteristics include hard stools, pale complexion, pale tongue with fine pulse. Medicinal herbs used include Angelica sinensis, Sesame seed, Polygonatum, Rehmannia glutinosa, Rehmannia, Radix Ophiopogonis, Citrus medica, Citrus aurantium, Citrus aurantium, Fried Astragalus, White Honey, etc.
2.2.3 Cold Constipation: Characteristics include difficult and dry stool, possible cold pain in the abdomen, preference for warmth and aversion to cold, pale tongue with white coating, deep slow pulse. Medicinal herbs used include Angelica sinensis, Epimedium, Cistanche, Saussurea, Citrus aurantium, Sesame seed, Raw Astragalus, etc.
2.2.4 Qi Constipation: Characteristics include hard stools, frequent belching, abdominal distension and pain, fullness in the chest and flanks, thin greasy coating, wiry pulse. Medicinal herbs used include Saussurea, Areca catechu, Citrus medica, Turmeric, Citrus aurantium, Sesame seed, Bupleurum, Chicken gizzard lining, etc.
2.2.5 Hot Constipation: Characteristics include dry stools, thirst preferring cold drinks, yellow dry coating, rapid pulse. Medicinal herbs used include Rhubarb, Fried Citrus aurantium, White Peony, Rehmannia glutinosa, Radix Ophiopogonis, Raw Astragalus, etc.
3 Typical Cases
3.1 Female patient, 65 years old. Long-term constipation accompanied by lower back pain and coldness, occasional abdominal distension, poor appetite. Pale tongue with thin white coating, deep pulse. Diagnosis: Spleen and kidney yang deficiency, treatment involves warming and tonifying the spleen and kidney. Prescription: 10g Epimedium, 20g Cistanche, 15g Raw Astragalus, 10g Citrus medica, 10g Citrus aurantium, 15g Raw Hawthorn, 15g Angelica sinensis, 10g Achyranthes root, 15g Polygonum multiflorum. The patient's weak constitution leads to internal generation of cold, powerless intestinal transmission, hence constipation. Kidney yang insufficiency leads to lower back pain and coldness. Weak spleen unable to transform and transport leads to abdominal distension and poor appetite. Epimedium, Achyranthes root warm the kidneys and assist yang, Cistanche tonifies kidney yang, moistens the intestines and promotes defecation, Citrus medica, Citrus aurantium regulate qi, Polygonum multiflorum, Angelica sinensis nourish blood and promote qi circulation, moisten the intestines and promote defecation. After 5 doses, daily bowel movements were achieved. Subsequent treatments followed the same prescription for adjustment.
3.2 Male patient, 92 years old. Previously underwent subtotal gastrectomy due to gastric cancer, subsequently had bowel movements every few days or weekly. Had previously used fire-purgative products, which caused diarrhea after consumption. Occasionally experienced abdominal distension, fatigue, pale complexion, coughing, phlegm, thin yellow slightly greasy coating, fine pulse. Diagnosis: Qi and blood deficiency, treatment involves replenishing qi and blood, moisturizing the intestines and promoting defecation. Prescription: 15g Raw Astragalus, 15g Poria, 15g太子参 (Prince Ginseng), 20g Trichosanthes, 15g Citrus medica, 15g Citrus aurantium, 10g Saussurea, 10g Acorus tatarinowii, 15g Angelica sinensis, 15g Raw Hawthorn, 15g White Peony. The patient’s qi and blood deficiency, weak spleen unable to transform and transport leads to constipation and abdominal distension. Water cannot be transformed, accumulating into phlegm. Weak spleen without source of qi and blood production leads to pale complexion and fatigue. Raw Astragalus, Poria, Prince Ginseng strengthen the spleen and replenish qi, Angelica sinensis, White Peony nourish blood and moisturize dryness, Citrus medica, Citrus aurantium, Saussurea, Acorus tatarinowii regulate qi to aid spleen transformation, Raw Hawthorn strengthens digestion, Trichosanthes clears phlegm-heat and also moistens the intestines and promotes defecation. After 5 doses, normal bowel movements occurred every 1-2 days. Subsequent treatments adjusted based on the same prescription, mainly focusing on strengthening the spleen, replenishing qi, nourishing blood, and moisturizing dryness for regulation.
4 Discussion
In the elderly, weakened organ functions and powerless intestinal transmission often lead to constipation. The main types are deficient constipation, cold constipation, and qi constipation. During treatment, one should not recklessly use fire-purgative medicines but rather focus on moistening the intestines and promoting defecation while simultaneously adding qi-regulating and spleen-strengthening ingredients. Although dietary habits and diseases such as alcohol consumption or overeating spicy and rich foods may also cause hot constipation, they are mostly mixed with deficiency and excess. Therefore, one should be cautious in using fire-purgative and qi-disrupting medicines. If laxatives are used for a long time or in excessive amounts, it will interfere with normal reflexes, leading to drug dependence, while also damaging qi, blood, and body fluids, causing dryness in the intestines, thereby worsening constipation. Application of laxatives must stop once the condition improves, and after relief of constipation, the laxative should be removed, continuing treatment according to the cause, applying methods such as strengthening the spleen, replenishing qi, warming yang, nourishing blood, and moisturizing dryness to treat the root cause and prevent recurrence of constipation.