Study On Medication Rules For Treating Constipation in Revised Ancient And Modern Famous Doctors Clinical Evidence ：Diarrhea And Constipation Volume
Apr 21, 2025
Abstract：
Objective： To summarize the medication rules for treating constipation by famous doctors throughout history based on data mining technology and provide a reference for clinical treatment of constipation.
Methods： Effective experienced prescriptions for treating constipation by famous doctors throughout history in Revised Ancient and Modern Famous Doctors Clinical Evidence： Diarrhea and Constipation Volume were collected and a prescription medication database was established via Excel 2019. The Ancient and Modern Medical Case Cloud Platform (V2.3.8), VOSviewer, Cytoscape 3.9.0 software were used for medication frequency analysis, medicinal property analysis, association rule analysis, cluster analysis, and complex network analysis to study the medication rules for treating constipation.
Results：f 191 prescriptions involving 208 Chinese medicinals with 1 565 medication frequencies were included. The high-frequency Chinese medicinals mainly included Angelicae Sinensis Radix, Cannabis Fructus, Rhei Radix et Rhizoma, Cistanches Herba, Citri Reticulatae Pericarpium, Glycyrrhizae Radix et Rhizoma and Rehmanniae Radix. The medicinal properties were mainly warm, cold,and neutr al; the medicinal flavors were mainly sweet,b itter, and acrid ;and the channel entries were mainly related to the five zang-organ s,stomach channel, and large intestine channel. The high-frequency Chinese medicinals were mainly categorized into deficiency-supplementing medicinals (26.26%), qi-rectifying medicinals (12.72%), heat-clearing medicinals (11.31%), purgative medicinals(11.05%), and medicinals for dissolving phlegm, easing cough, and relieving panting (8.56%). Cluster analysis showed that high-frequency Chinese medicinals could be clustered into five categories. Association rule analysis suggested that Magnoliae Officinalis Cortex-Rhei Radix et Rhizoma,Pruni Semen-Cistanches Herba and Cistanches Herba-Angelicae Sinensis Radix were commonly used medicinal pairs.
Conclusion： The Chinese medicinals used by famous doctors throughout history in Revised Ancient and Modern Famous Doctors Clinical Evidence： Diarrhea and Constipation Volume for treating constipation mainly focus on warming the kidney and boosting essence,strengthening the spleen and rectifying qi,and moistening the intestines and promoting defecation,which can provide a basis for clinical prescription and medication. Keywords：Revised Ancient and Modern Famous Doctors Clinical Evidence：Diarrhea and Constipation Volume; Constipation;Data mining;Medication rules
Herbal Cistanche Supplements For Constipation
Constipation is a common gastrointestinal disorder in clinical practice, mainly characterized by difficulty in defecation, prolonged defecation cycles, or normal cycles with dry, hard stools that are difficult to expel [1]. Traditional Chinese Medicine (TCM) has a long history of understanding and treating constipation. Numerous studies have shown that TCM treatments for constipation are highly effective, with minimal side effects and low dependency[2-4]. This study analyzes the empirical formulas for treating constipation recorded in the Revised Medical Classics of Ancient and Modern Famous Physicians: Diarrhea and Constipation Volume to explore the patterns in their formulation and medication use, providing a reference for clinical practice.
1 Materials and Methods
1.1 Data Source
The Revised Medical Classics of Ancient and Modern Famous Physicians: Diarrhea and Constipation Volume [5] includes the empirical formulas of Ming and Qing dynasty physicians, as well as renowned contemporary and modern TCM doctors, for treating constipation. It documents detailed clinical experiences in constipation treatment. This study selected effective empirical formulas for treating constipation from the text, involving 38 physicians, including Zhang Congzheng, Wang Kentang, Zhang Jingyue, Ye Tianshi, Miao Xiyong, Xiong Jibo, and Wang Qi.
1.2 Prescription Screening Criteria
1.2.1 Inclusion Criteria:
Subjects met the diagnostic criteria for constipation.
Prescription records were complete.
Efficacy of the medication was confirmed.
When follow-up prescriptions were identical to the initial ones, only one prescription was retained.
1.2.2 Exclusion Criteria:
Prescriptions that did not involve oral medication.
Patients with other severe comorbidities.
1.3 Data Standardization
The names of the herbs were standardized according to the 2020 edition of the Pharmacopoeia of the People's Republic of China: Volume I [6] and Chinese Materia Medica [7]. For example, "Shanzhi" was standardized to "Zhizi," "Chuanlian" to "Huanglian," and "Shanyurou" to "Shanzhuyu." The categorization of herbs was also based on Chinese Materia Medica [7].
1.4 Data Analysis
The Ancient and Modern Medical Cases Cloud Platform (https://www.yiankb.com/) was developed by the Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences. It plays an important role in summarizing and inheriting the formulation and medication patterns of famous physicians [8-9]. Data on the herbal prescriptions were entered into a database using Excel 2019 by two individuals to ensure accuracy. The platform (version 2.3.8) was used to analyze the frequency, properties, flavors, meridian tropism, and functional categories of the herbs, as well as the association rules between the herbs. VOSviewer software was used for herbal clustering analysis, and Cytoscape 3.9.0 software was used to construct a complex network of herbal associations.
2 Results
2.1 Frequency of Herb Usage
A total of 191 prescriptions were included, involving 208 herbs with a total usage frequency of 1,565 times. Herbs used with a frequency of ≥20 times totaled 19 (Table 1). Herbs accounting for more than 20% of the total formula usage (herb frequency/formula count × 100%) included 8 herbs: Angelicae Sinensis Radix (Danggui), Cannabis Semen (Huomaren), Rheum (Dahuang), Cistanches Herba (Roucongrong), Citri Reticulatae Pericarpium (Chenpi), Glycyrrhizae Radix et Rhizoma (Gancao), Rehmanniae Radix (Shengdihuang), and Aurantii Fructus (Zhike).
2.2 Herb Properties
The properties of the 208 herbs were analyzed, and the results are summarized as follows:
Nature: Mainly warm, cold, and neutral (Table 2).
Flavor: Predominantly sweet, bitter, and pungent (Table 3).
Meridian Tropism: Primarily associated with the five viscera, the stomach meridian, and the large intestine meridian (Table 4).
Table 1: High-Frequency Herbs in 191 Prescriptions for Treating Constipation (Frequency ≥ 20)
| Rank | Herb Name | Frequency | Percentage (%) |
|---|---|---|---|
| 1 | Angelicae Sinensis Radix (Danggui) | 66 | 34.6 |
| 2 | Cannabis Semen (Huomaren) | 64 | 33.5 |
| 3 | Rheum (Dahuang) | 54 | 28.3 |
| 4 | Cistanches Herba (Roucongrong) | 54 | 28.3 |
| 5 | Citri Reticulatae Pericarpium (Chenpi) | 42 | 22.0 |
| 6 | Glycyrrhizae Radix et Rhizoma (Gancao) | 39 | 20.4 |
| 7 | Rehmanniae Radix (Shengdihuang) | 33 | 17.3 |
| 8 | Aurantii Fructus (Zhike) | 30 | 15.7 |
| 9 | Paeoniae Radix Alba (Baishao) | 29 | 15.2 |
| 10 | Magnoliae Officinalis Cortex (Houpo) | 26 | 13.6 |
| 11 | Zingiberis Rhizoma Recens (Shengjiang) | 25 | 13.1 |
| 12 | Arecae Semen (Binglang) | 23 | 12.0 |
| 13 | Aucklandiae Radix (Muxiang) | 22 | 11.5 |
| 14 | Atractylodis Macrocephalae Rhizoma (Baizhu) | 22 | 11.5 |
| 15 | Crataegi Fructus (Shanzha) | 21 | 11.0 |
| 16 | Poria (Fuling) | 20 | 10.5 |
Table 2: Properties of 208 Herbs in Constipation Treatment
| Property | Herb Count | Percentage (%) |
|---|---|---|
| Warm | 80 | 38.5 |
| Cold | 65 | 31.3 |
| Neutral | 63 | 30.3 |
Table 3: Flavors of 208 Herbs in Constipation Treatment
| Flavor | Herb Count | Percentage (%) |
|---|---|---|
| Sweet | 84 | 40.4 |
| Bitter | 78 | 37.5 |
| Pungent | 46 | 22.1 |
Table 4: Meridian Tropism of 208 Herbs in Constipation Treatment
| Meridian | Herb Count | Percentage (%) |
|---|---|---|
| Large Intestine | 83 | 39.9 |
| Spleen | 66 | 31.7 |
| Stomach | 64 | 30.8 |
| Liver | 53 | 25.5 |
| Kidney | 44 | 21.2 |
| Lung | 38 | 18.3 |
2.3 Functional Categories of Herbs
The 208 herbs were classified into 19 functional categories. Categories with usage frequencies exceeding 100 were tonifying herbs, qi-regulating herbs, heat-clearing herbs, purgative herbs, and phlegm-resolving and cough/asthma-relieving herbs, as shown in Table 5.
2.4 Clustering Analysis
The VOSviewer software reveals the intensity and relationships among items through the color, size, and clustering of nodes in the network [10-11]. In this study, clustering analysis was performed using VOSviewer for herbs with a usage frequency of ≥5. The results are shown in Figure 1.
Different colors represent different clusters, with the same color indicating close relationships.
Each node represents an herb, and the larger the node, the higher the usage frequency of the herb.
Lines between nodes indicate relationships between herbs.
A total of 89 herbs were identified, classified into 5 clusters:
Table 5: Functional Categories of 208 Herbs Used in Constipation Treatment
| Rank | Functional Category | Herb Count | Frequency | Percentage (%) |
|---|---|---|---|---|
| 1 | Tonifying Herbs | 40 | 411 | 26.26 |
| 2 | Qi-Regulating Herbs | 22 | 177 | 11.31 |
| 3 | Phlegm-Resolving & Cough/Relieving Herbs | 44 | 172 | 10.99 |
| 4 | Blood-Activating & Stasis-Removing Herbs | 15 | 150 | 9.58 |
| 5 | Purgative Herbs | 14 | 145 | 9.27 |
| 6 | Heat-Clearing Herbs | 33 | 131 | 8.37 |
| 7 | Qi-Boosting Herbs | 7 | 110 | 7.02 |
| 8 | Astringent Herbs | 15 | 94 | 6.01 |
| 9 | Warm-Interior Herbs | 10 | 70 | 4.47 |
| 10 | Digestive Herbs | 7 | 66 | 4.22 |
| 11 | Dampness-Resolving Herbs | 6 | 58 | 3.71 |
| 12 | Blood-Tonifying Herbs | 3 | 54 | 3.45 |
| 13 | Yin-Tonifying Herbs | 4 | 40 | 2.55 |
| 14 | Diuretic Herbs | 1 | 20 | 1.28 |
| 15 | Wind-Damp Expelling Herbs | 1 | 14 | 0.89 |
| 16 | Exterior-Releasing Herbs | 1 | 11 | 0.70 |
| 17 | Parasite-Expelling Herbs | 1 | 10 | 0.64 |
| 18 | Insecticidal Herbs | 1 | 6 | 0.38 |
| 19 | Hemostasis Herbs | 1 | 5 | 0.32 |
