A Comprehensive Analysis Of Traditional Chinese Medicine Prescriptions For Constipation
Apr 21, 2025
3 Discussion
This study analyzed 191 prescriptions from 38 physicians in the Revised Medical Classics of Ancient and Modern Famous Physicians: Diarrhea and Constipation Volume, involving 208 herbs. The top five functional categories of herbs by frequency were tonifying herbs, qi-regulating herbs, heat-clearing herbs, purgative herbs, and phlegm-resolving and cough/asthma-relieving herbs.
The primary pathogenesis of constipation is the dysfunction of the large intestine's transmission, which involves multiple organs such as the spleen, stomach, kidneys, and lungs. Therefore, the most commonly used category is tonifying herbs, such as Angelicae Sinensis Radix (Danggui) and Cistanches Herba (Roucongrong), supplemented by herbs that strengthen the spleen, regulate qi, disperse the lungs, and moisten the intestines.
3.1 High-Frequency Herbs
High-frequency herbs include Angelicae Sinensis Radix (Danggui), Cannabis Semen (Huomaren), Rheum (Dahuang), Cistanches Herba (Roucongrong), Citri Reticulatae Pericarpium (Chenpi), Rehmanniae Radix (Shengdihuang), Aurantii Fructus (Zhike), Paeoniae Radix Alba (Baishao), Armeniacae Semen Amarum (Kuxingren), Poria (Fuling), Aurantii Fructus Immaturus (Zhishi), and Magnoliae Officinalis Cortex (Houpo).
Angelicae Sinensis Radix: Known for its blood-tonifying, blood-activating, and intestine-moistening effects. Ben Cao Xin Bian records, "Dry stools cannot be expelled without the use of Danggui." Modern pharmacological studies confirm that Danggui can effectively treat blood-deficiency constipation by regulating aquaporin-4 and aquaporin-8 [12-13].
Cistanches Herba: Has kidney-tonifying, yang-enhancing, and intestine-moistening effects. When combined with Danggui, Cannabis Semen, and Paeoniae Radix Alba, it is used for blood deficiency and dryness-induced constipation. Modern research has shown that Cistanches Herba can improve symptoms of functional constipation by increasing the activity of interstitial cells of Cajal through the SCF/c-kit signaling pathway, thereby enhancing colonic sensitivity [14-15].
Herbal Cistanche Supplements For Serious Constipation
Rheum: Its bitter and cold nature gives it purgative and heat-clearing effects. When combined with Aurantii Fructus Immaturus and Magnoliae Officinalis Cortex, it enhances purgative effects. Modern pharmacology confirms that Rheum promotes bowel movements and increases intestinal peristalsis [16-17].
3.2 Herb Properties and Flavors
Analysis of the 208 herbs showed:
Properties: Mainly warm, cold, and neutral.
Flavors: Predominantly sweet, bitter, and pungent.
Meridians: Primarily associated with the five viscera, the stomach meridian, and the large intestine meridian.
As described in Jingyue Quanshu: Secret Constipation, "In elderly, weak, or postpartum people, constipation is often caused by blood and qi deficiency or depletion of fluids." Clinically, functional constipation is common, and warm herbs like Danggui, Cistanches Herba, Cannabis Semen, and Suo Yang can warm and moisten the intestines, while Rehmanniae Radix, Scrophulariae Radix, and Ophiopogonis Radix replenish fluids, lubricating the intestines and promoting defecation.
Constipation is closely related to the spleen and stomach. Ling Shu: Meridian states, "When the stomach is in excess, there is abdominal distension and a tendency to hunger; when deficient, there is cold and fullness." Similarly, the liver's role in regulating qi flow is significant in treating constipation, as seen in the use of Xiao Chaihu Tang, which harmonizes the liver and stomach, ensures smooth qi flow, and promotes defecation [18]. Master TCM physician Xu Jingfan highlights that lung qi dysfunction and impaired ascending and descending functions are key mechanisms in constipation, and treatment should focus on the lungs for cases of lung qi stagnation [19].
3.3 Clustering Analysis
Clustering analysis identified five clusters of herbs:
Cluster ①: Represents Jichuan Decoction combined with Wenpi Decoction for deficiency-induced constipation. The formula includes Cistanches Herba, Angelicae Sinensis Radix, Achyranthis Bidentatae Radix, Rehmanniae Radix Praeparata, Lycii Fructus, Cuscutae Semen, Cinnamomi Cortex, Zingiberis Rhizoma, and Aconiti Lateralis Radix Praeparata. These herbs warm the kidneys, strengthen yang, and promote defecation.
Cluster ②: Represents Maziren Pill, which includes Cannabis Semen, Persicae Semen, Pruni Semen, and Armeniacae Semen Amarum. These herbs moisten the intestines, clear obstructions, and facilitate defecation.
Cluster ③: Represents Xiao Chengqi Decoction, with Rheum, Aurantii Fructus, and Magnoliae Officinalis Cortex, to promote bowel movements.
Cluster ④: Represents Liu Mo Decoction, with qi-regulating herbs like Citri Reticulatae Pericarpium, Aucklandiae Radix, and Toosendan Fructus, to relieve stagnation and promote defecation.
Cluster ⑤: Represents Zengye Decoction, which replenishes fluids with Rehmanniae Radix, Ophiopogonis Radix, and Scrophulariae Radix.
3.4 Association Rule Analysis
Association rule analysis identified the strongest association between Magnoliae Officinalis Cortex and Rheum. The combination enhances purgative effects, as Rheum promotes bowel movements, and Magnoliae Officinalis Cortex eliminates stagnation. The highest support rate was found between Cannabis Semen and Angelicae Sinensis Radix, as well as Cistanches Herba and Angelicae Sinensis Radix. These combinations promote defecation by moistening the intestines and replenishing qi and blood.
Conclusion
This study systematically analyzed 191 effective prescriptions from the Revised Medical Classics. Commonly used formulas include Jichuan Decoction, Maziren Pill, Xiao Chengqi Decoction, Liu Mo Decoction, and Zengye Decoction, which focus on warming the kidneys, regulating qi, strengthening the spleen, and moistening the intestines. These findings provide valuable references for clinical treatment of constipation.
