Definition
Western
Prolonged retention of the products of digestion within the intestinal canal due to infrequent or incomplete defaecations [1].
Traditional Chinese Medicine (TCM)
A condition in which faecal matter resides in the intestines for over an extended duration, resulting in prolonged intervals between successive defaecations, or experiencing difficult and/or painful defaecation with dry stools or feelings of incomplete emptying of bowels [2-3].
Symptoms
Symptoms include hard stools, difficulty in defaecation, abdominal pain or fullness, nausea, irregular defaecation [4] or the after feeling of incomplete emptying[5].
Classifications and Accompanying Symptoms in TCM Context
High Metabolism
· High metabolic rate results in increased production of faecal matter. However, if excretion rate remains unchanged, faecal matter may accumulate inside the body as a result.
· Manifests as difficult defaecation, dry or hard stools, abdominal pain, decrease in appetite, flushed complexion or constant burping or flatulence.
Weak Physiological State
· Poor functioning of the digestive system leads to slow excretory rate, which may in turn result in retention of faecal matter in the body.
· Manifests as a feeling of lethargy after defaecation, shortness of breath, uncontrolled sweating, heart palpitations, pale complexion, dizziness, ringing in the ear or cold sensation in the abdominal area [2-3].
Causes
According to the TCM theories, the principal reason for constipation is the loss or reduction of the transmission function along the large intestines. Factors contributing to this paralysis include dietary and emotional imbalance, pathogenic factors or weak body state. Insufficient physical activities, excessive intake of alcohol or overindulgence of spicy and oily foods may impede the movements of the intestinal tract [2-3].
Risk Factors
1. Constipation is more common in women [4], especially during pregnancy [5] .This is largely attributed to alterations in hormones or mechanical compressions caused by an enlarging uterus with the growing foetus [6].
2. Individuals with underlying medical conditions, such as hypothyroidism, diabetes, neurological illness and psychiatric diseases, may have increased tendency of constipation [7] .
3. Major changes in daily diets, such as those in commercial slimming programmes may also trigger unnecessary constipated conditions.
Treatments
Herbal prescriptions: Commonly used include
1. Da Huang -大黄
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English/ Common name
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Chinese Rhubarb[8]
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Latin species
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Rheum palmatum L. [9]
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Park of plant used
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Rhizomes
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Action/s
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Found to have laxative effects [9-10] and at the same time, helps in promoting intestinal movements and improving blood circulation. Effectively eliminates retained matter and toxins [9, 11] and is also used in the treatment of pain in the gums, sore throat[8] and some digestive diseases [9, 12] .
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Precaution/s
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Women who are pregnant, breastfeeding or having menstruations should not consume this herb [9].
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2. Huo Ma Ren -火麻仁
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English/ Common name
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Hemp Seeds
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Latin species
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Cannabis sativa L. [9]
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Park of plant used
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Seeds
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Action/s
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Acts like a mild laxative by facilitating defaecation and inducing bowel movements [13] .
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Precaution/s
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Individuals who are prone to chronic diarrhoea should avoid consuming this herb.
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3. Shan Zha -山楂
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English/ Common name
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Chinese hawthorn berries[14]
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Latin species
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Crataegus pinnatifida Bge. var. major N. E. Br.[9]
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Park of plant used
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Fruit [15]
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Action/s
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Helps to promote digestion of food and smooth blood circulation. Also showed benefits to certain cardiovascular ailments [14-16].
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Precaution/s
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Individuals with poor digestive system should use this herb with caution. Pregnant women should avoid this herb [9] .
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4. Fan Xie Ye -番泻叶
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English/ Common name
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Senna [17-18]
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Latin species
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Cassia angustifolia Vahl[9]
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Park of plant used
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Leaves
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Action/s
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Helps to accelerate defaecation [9] through stimulation of the intestinal walls. Also been used in the treatment of intestinal worms [17-18].
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Precaution/s
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Women who are pregnant, breastfeeding or having menstruation should avoid this herb [9,11].
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Massage
Abdominal massage, consisting of 4 basic strokes, is performed in a clock-wise direction around the presumed course of the large intestines on a relaxed abdominal wall for 15 to 20 minutes. This form of treatment aims to enhance the mass movement in the intestines. However, women who are pregnant, breastfeeding or having menstruation should not perform this abdominal massage at all [19] .
Tests & Diagnosis
· Physical examination should be performed by clinicians. Rectal examination is performed on males while vaginal/anal examination is performed on females [5, 7].
· Evacuation proctography: A simple, rapid and acceptable examination to quantify contents of rectal evacuation [4].
Lifestyle
· Take time out for brisk walking or running for 15 to 20 minutes every morning.
· Practice abdominal breathing for 30 to 40 minutes every day.
· Increase intake of vegetables, fruits and water. Avoid spicy, oily and cold foods. Some examples of cold foods include raw meat and vegetables and iced drinks [20].
References
1. McKenney, J.A., The physiologic use of water in constipation. American Journal of Digestive Diseases, 2008. 13(3): p. 78-80.
2. Liu, Z., Constipation, in Essentials of Chinese Medicine 2009.
3. Ying, Z.Z., 中医内科学. 2008: 中国中医药出版社.
4. D. Kumar, D.C.C.B., G. Devroede et al, Symposium on constipation International Journal of Colorectal Disease, 2004. 7(2).
5. Chiarelli, P., Constipation in Therapeutic Management of Incontinence and Pelvic Pain, J.H.a.J. Laycock, Editor. 2007.
6. Szarka, N.R.F.a.L.A., Extracolonic Causes of Constipation in Constipation: Etiology, Evaluation, and Management, S.D.W.a.G.S. Duthie, Editor. 2006.
7. David E. Beck, P.L.R., John L. Rombeau, Michael J. Stamos and Steven D. Wexner, Constipation and Irritable Bowel Syndrome in The ASCRS Manual of Colon and Rectal Surgery M.J.S. Steven D. Wexner, John Rombeau et al, Editor. 2009.
8. Ruilin Hu, Y.L., Xiaojing Dai, Yuanjiang Pan Screening of antioxidant phenolic compounds in Chinese Rhubarb combining fast counter-current chromatography fractionation and liquid chromatography/mass spectrometry analysis. Journal of Separation Science, 2010. 33(11): p. 1595-1603.
9. Fu, Z.Y., 中药学. 2003: 上海中医药大学出版社.
10. J. Wang, H.Z., W. Kong et al, Microcalorimetric assay on the antimicrobial property of five hydroxyanthraquinone derivatives in rhubarb (Rheum palmatum L.) to Bifidobacterium adolescentis Phytomedicine, 2010. 17(8-9): p. 684-689.
11. Liu, Z., Commonly Used Herbs in Essentials of Chinese Medicine 2009.
12. Cui XY, W.Y., Kokudo N, Fang DZ, Tang W Traditional Chinese medicine and related active compounds against hepatitis B virus infection. . BioScience Trends, 2010. 4(2): p. 39-47.
13. Jong-Chang Tsai, S.T.a.W.-C.C., Effect of Ethanol Extracts of Three Chinese Medicinal Plants with Laxative Properties on Ion Transport of the Rat Intestinal Epithelia. Biological & Pharmaceutical Bulletin, 2004. 27.
14. Hyung-In Moon, T.-i.K., Hyun-Soo Cho and Eung Kweon Kim, Identification of potential and selective collagenase, gelatinase inhibitors from Crataegus pinnatifida Bioorganic & Medicinal Chemistry Letters, 2010. 20(3): p. 991-993.
15. Pengzhan Liu, H.K., Deguo Lu et al, Acids, Sugars, and Sugar Alcohols in Chinese Hawthorn (Crataegus spp.) Fruits. Journal of Agricultural and Food Chemistry, 2010. 58(2): p. 1012-1019.
16. Daih-Huang Kuo, C.-H.Y., Po-Chuen Shieh, Effect of ShanZha, a Chinese herbal product, on obesity and dyslipidemia in hamsters receiving high-fat diet Journal of Ethnopharmacology, 2009. 124(3): p. 544-550.