The patient was a woman in her early sixties, a retired teacher, who came to the clinic for constipation she described with some embarrassment as “my stones.” Her stools were dry, small, and hard — she said passing them was like passing pebbles — every two or three days, sometimes less. She had already tried the obvious remedies. Over-the-counter senna made her cramp and left her exhausted the next day. Prunes helped a little. Extra water, extra vegetables, a fiber supplement: all tried, none decisive. She had lived with the problem for nearly four years and had come to regard it as her age arriving early.
Her Western workup was unremarkable, and her first Western treatments had been reasonable — bulk fiber, osmotic agents. But in the clinic, the rest of her story reorganized the picture. She reported a dry mouth that was worst at night, waking her to sip water. Her sleep was shallow, with vivid dreams. Her cheeks were faintly flushed in the afternoon. Her tongue was red, narrow, and almost without coating, with fine cracks down the center, and her pulse was thin and slightly rapid. Her hands were warm, but she felt heat in her palms and soles in the evening — the kind of heat that makes you stick your feet out of the blankets and then pull them back.
Nothing in this picture pointed at heat blocking the bowels, and nothing pointed at a lazy bowel that needed whipping. The picture was dryness — a shortage of the fluids themselves. In Chinese medicine, stool is not just waste under pressure; it is a boat on a river. When the river runs low, the boat grinds on the gravel. Purging herbs like senna are boats dragged by force: they move, but they scrape, and they leave the river even lower. Her exhaustion after every dose of senna was the body reporting exactly that.
The classical name for her pattern is 阴虚肠燥 — yin deficiency with intestinal dryness — common in women after sixty, whose deep fluids have thinned with age. The treatment principle follows a famous instruction from the Ming dynasty physician Wu Jutong: 增水行舟 — increase the water so the boat floats. The formula was 增液汤 — the Increase the Fluids Decoction — just three herbs, all of them moistening rather than moving: 玄参 (Scrophularia), 麦冬 (Ophiopogon), and 生地黄 (Rehmannia). No senna, no rhubarb, no cramping. The aim was not to push the stool out but to refill the riverbed — to restore the fluids of the intestines so that passage became possible on its own.
She took the formula as a decoction, twice daily. By the fourth day she reported stools every other day that were “at least twice the size,” passed without straining. After three weeks the pattern had settled into daily, soft, easy passages, and the night thirst had quieted. The afternoon heat in her palms faded. We adjusted the formula to a gentler, pill form for maintenance, alongside instructions that read less like medicine and more like common sense for a drying body: warm cooked foods, soups, congee, earlier bedtimes, and no more heroic cleanses. Two years later she still uses the pills intermittently in dry weather and has not needed a purge since.
Cases like this one are why Chinese medicine refuses to treat “constipation” as a single disease. The same complaint can come from heat, from cold, from qi that is too weak to move, from blood that is too thin to moisten, or — as here — from fluids simply run low. Five patients, five patterns, five different formulas. The complaint is the boat; the treatment asks about the river. That is not mysticism. It is the insistence that a symptom is a piece of evidence, and evidence must be read in context — and that sometimes the most effective medicine is not force, but supply.
Professor Zhao Hanqing is a senior TCM practitioner at Beijing Heniantang, specializing in traditional Chinese medicine theory, classical formula research, and TCM informatics. With years of clinical experience and academic dedication, Professor Zhao bridges the wisdom of ancient Chinese medical classics with modern computational approaches to advance the field of TCM knowledge systems.
Disclaimer: This article is presented for educational and informational purposes. Individual results may vary. Always consult qualified healthcare providers before beginning any treatment.
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