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Professor Wang Mianzhi of Beijing University of Chinese Medicine has been engaged in clinical practice, teaching, and scientific research in traditional Chinese medicine for over 50 years. He has accumulated extensive experience in treating various complex and refractory diseases, demonstrating profound knowledge and remarkable therapeutic efficacy. Among numerous conditions, Professor Wang's approach to treating constipation is particularly distinctive. This article summarizes his experience and academic insights in managing this condition.

Careful Differentiation of Causes, Treating the Root of the Disease

In clinical diagnosis and treatment of constipation, Professor Wang attaches great importance to identifying the causes of constipation and often advises his students on the crucial role of TCM etiology theory in disease management. He emphasizes that while dietary factors are indeed a primary cause of constipation, emotional factors also play a significant role in its onset. If emotional disturbances occur, they can affect the qi movement of the zang-fu organs, leading to dysfunction of the large intestine's transmission, thereby resulting in constipation. Professor Wang thoroughly investigates the root causes of constipation, identifying whether it stems from dietary damage, emotional disturbances, or fatigue. He distinguishes between deficiency and excess, cold and heat, examines phlegm, blood stasis, dampness, and qi, strategizes meticulously, formulates prescriptions carefully, and consistently achieves remarkable therapeutic outcomes.

Emphasizing the Zang-Fu Organs and Regulating Qi Movement

Ultimately, constipation affects the transmission function of the gastrointestinal tract. As stated in "Suwen·Linglan Mi Dian Lun": "The large intestine is the official of transmission, responsible for transformation." Impaired gastrointestinal transmission and obstructed qi movement in the large intestine lead to stagnation of qi in the zang-fu organs and disruption of the spleen and stomach's ascending and descending functions. Professor Wang's pattern differentiation for constipation closely revolves around the fundamental pathogenesis of obstructed qi movement in the large intestine. Adhering to the principle that "the six fu organs function by maintaining patency," his treatment strategies focus on restoring the large intestine's transmission by regulating its qi movement—whether through warming to promote flow, supplementing to facilitate movement, or clearing to remove obstruction—without being confined to a single approach.

Professor Wang believes that dysfunction of any of the five zang and six fu organs can lead to constipation. In terms of physiological functions, the lungs and large intestine are interior-exteriorly related; the transmission of the large intestine depends on the lung qi's descending function. Additionally, the free flow of liver qi, the nourishing function of heart blood, and the abundance of kidney essence are all directly related to the normal physiological functions of the large intestine. Among these, the kidneys physiologically govern the two lower orifices (urination and defecation), so the balance of kidney yin and yang directly affects the normal excretion of urine and stool. Once the physiological functions of these organs are disrupted, they can affect the normal function of the large intestine and lead to constipation.

Among them, lung and liver affecting the large intestine often involve disharmony of qi movement, while heart and kidney affecting the large intestine typically involve deficiency of yin and blood or lack of warmth due to yang deficiency. However, among the five zang organs, Professor Wang particularly emphasizes the role of spleen and stomach function in the occurrence and treatment of constipation. The spleen and stomach reside in the middle jiao and are responsible for the transportation, distribution, and dispersion of food essence. The essence is elevated and distributed by spleen qi, while the dregs are excreted from the body following the descending function of stomach qi. The normal digestion and absorption of food rely on this ascending of the clear and descending of the turbid by the spleen and stomach. Once the functions of the internal organs become imbalanced, affecting the ascending and descending functions of the spleen and stomach, the transmission function of the large intestine becomes disordered, leading to constipation or diarrhea. Constipation, in turn, directly affects the ascending of the clear and descending of the turbid by the spleen and stomach, resulting in symptoms such as dizziness, nausea, vomiting, and loss of appetite.

Professor Wang believes that constipation in the elderly is primarily due to the decline of organ functions, along with the depletion of kidney yin essence and yang qi, resulting in the large intestine losing the warming, propulsion, and nourishment of yang qi and yin fluids. He succinctly summarizes the pathological characteristics of constipation in the elderly, forming a syndrome differentiation system centered on organ functions.

Regulating the Spleen and Stomach to Integrate Multiple Strengths

Based on years of clinical practice, Professor Wang continuously explored and summarized his experience, creating Wang's Constipation-Relieving Decoction, which has achieved excellent results. Wang's Constipation-Relieving Decoction integrates the formulation characteristics of Zhi Zhu Wan (Immature Bitter Orange and Atractylodes Macrocephala Pill), Zhi Shi Dao Zhi Wan (Immature Bitter Orange Pill to Guide Out Stagnation), Jian Pi Wan (Spleen-Fortifying Pill), and Mu Xiang Bing Lang Wan (Costus Root and Areca Pill). It was developed considering that constipation in modern people is often related to irregular diet, impaired transportation, and dysfunctional transmission. In the formula, Atractylodes macrocephala (Bai Zhu), with its bitter, sweet, and warm properties, serves as the sovereign herb, entering the spleen and stomach meridians. It tonifies qi and fortifies the spleen, aiding the spleen and stomach in transportation and transformation. "Ben Cao Tong Xuan" states: "Atractylodes macrocephala is a medicinal herb that tonifies the spleen and stomach...," and "Ben Cao Qiu Zhen" describes it as "capable of both drying dampness and strengthening the spleen, as well as moderating the spleen and generating fluids. Moreover, its nature is extremely warm, and taking it can fortify the spleen and promote digestion. It is the foremost medicinal herb for tonifying spleen qi." Modern pharmacological research indicates that Atractylodes macrocephala can significantly promote gastric emptying and small intestine propulsion in mice. In the formula, immature bitter orange (Zhi Shi), Cyperus rotundus (Xiang Fu), and areca nut (Bing Lang) serve as minister herbs. Immature bitter orange can break qi, disperse accumulation, resolve phlegm, and eliminate distension. Its combination with Atractylodes macrocephala precisely replicates the formulation of Zhi Zhu Wan, which fortifies the spleen and stomach while dispersing accumulation and relieving fullness. Cyperus rotundus regulates liver qi and possesses harmonizing and descending properties. When liver qi is regulated and flowing smoothly, it assists in the healthy functioning of spleen and stomach qi, while its harmonizing and descending properties aid the large intestine in performing its transmission function.

Professor Wang skillfully applies the theory of organ correlation in the formulation of herbal prescriptions, which is the key to achieving excellent therapeutic effects. Areca nut, with its acrid dispersing and bitter draining properties, can both move Qi and resolve stagnation to guide out accumulation, as well as gently purge and unblock the bowels. The combination of the three herbs, under the leading role of Atractylodes macrocephala, works together to resolve stagnation and eliminate masses, soothe Qi movement, and guide out accumulation to relieve constipation. They have clear division of labor while complementing each other, achieving synergy, tonifying without causing stagnation, and breaking without causing depletion. Additionally, Crataegus pinnatifida, Gallus gallus domesticus internal membrane, Coptis chinensis, Quisqualis indica, and prepared Glycyrrhiza uralensis are used as supporting herbs. Crataegus pinnatifida is particularly effective in resolving meat stagnation, thereby enhancing the actions of Citrus aurantium and Areca nut in resolving accumulation and guiding out stagnation. Gallus gallus domesticus internal membrane clears heat generated from long-term food stagnation in the stomach and intestines. Quisqualis indica is selected for its ability to resolve stagnation, assisting the sovereign and minister herbs in strengthening the spleen and resolving accumulation. Prepared Glycyrrhiza uralensis helps Atractylodes macrocephala in strengthening the spleen and boosting Qi, while also harmonizing the properties of all herbs with its sweet and moderating nature. The combination of these herbs works together to strengthen the spleen and assist transportation, resolve stagnation, and relieve constipation.

Emphasizing Regulation and Nourishment, Prioritizing Life Cultivation

Professor Wang strongly advocates for the comprehensive treatment of constipation with Traditional Chinese Medicine combined with dietary adjustments, life cultivation, and other auxiliary therapies, emphasizing syndrome differentiation and treatment. When prescribing during clinical practice, he earnestly advises patients to maintain a balanced diet, establish regular bowel movements and routines in daily life, and avoid excessive worry, overthinking, anger, or irritation while maintaining a relaxed and cheerful state of mind.