Chinese medicine for constipation
By Dr (TCM) Attilio D'Alberto | Traditional Chinese Medicine Practitioner, Wokingham
On this page
- Overview
- What is constipation?
- Common causes
- TCM patterns
- Acupuncture for constipation
- Chinese herbal medicine
- Diet
- Lifestyle and self-care
- Supplements with evidence
- When to see a doctor
- Frequently asked questions
1. Overview
Constipation is one of the most common digestive complaints and one where traditional Chinese medicine offers genuinely effective, individualised treatment. Unlike laxatives — which produce a mechanical effect without addressing the cause — TCM treatment restores the Large Intestine’s normal function by correcting the underlying pattern. The result is lasting improvement rather than ongoing dependency. I am Dr (TCM) Attilio D’Alberto, with over 25 years of clinical experience treating digestive disorders.
2. What is constipation?
The Rome IV criteria define constipation as fewer than 3 bowel movements per week, with two or more of: straining, hard or pellet-like stools, sense of incomplete evacuation, sense of obstruction, manual manoeuvres needed, or loose stools rarely present without laxatives. Many people experience milder constipation that does not meet formal criteria but still affects quality of life. From a TCM perspective, a daily, complete, easy bowel movement is the goal — anything less is worth addressing.
3. Common causes
- Inadequate fibre and fluid intake — the most common modifiable cause
- Sedentary lifestyle — physical movement is essential for normal bowel function
- Stress and anxiety — activate the sympathetic nervous system, slowing gut motility
- Medication side effects — opioids, anticholinergics, iron, calcium-channel blockers, some antidepressants
- Hypothyroidism — slows gut motility
- Pregnancy — progesterone and pressure of the gravid uterus
- Pelvic floor dysfunction — difficulty coordinating muscle relaxation
- IBS-C — constipation-predominant irritable bowel syndrome (see Chinese medicine for IBS)
- Ageing — reduced motility, reduced fibre intake, more medications
- Chronic laxative use — can paradoxically worsen function over time
- Travel and routine disruption
- Holding the urge — repeatedly suppressing the urge desensitises the rectum
4. TCM patterns
Heat in the Large Intestine
Dry, hard stools, foul-smelling, thirst, strong appetite, abdominal distension, possibly haemorrhoids, red tongue with yellow coating. Common in people with rich diet (red meat, alcohol, spicy food), inadequate water intake or febrile illness.
Qi stagnation
Difficulty passing stool despite the urge, bloating, sense of incomplete evacuation, alternating with looser stools, stress-related, sighing, distension that improves with passing wind. Liver qi stagnation from chronic stress is the typical driver.
Qi deficiency (sinking)
Insufficient energy to move the bowel; soft stools that are difficult to pass, exhaustion after defecation, fatigue, breathlessness, pale tongue. Common in elderly patients, after long illness or pregnancy.
Blood deficiency
Dry stools, pale complexion, dizziness, dry skin and hair, scanty periods. Common postpartum and in women with heavy periods.
Yin deficiency
Dry stools resembling sheep pellets, dry mouth, dry skin, afternoon heat, night sweats, red tongue with little coating. Common in older adults and in perimenopause.
Yang deficiency / cold accumulation
Difficult to pass stools with cold sensation in the abdomen, cold extremities, frequent clear urination, pale tongue. Common in elderly and in chronic illness.
5. Acupuncture for constipation
Acupuncture regulates colonic motility through direct effects on the autonomic nervous system. Multiple randomised trials show improvements in bowel frequency, stool form and quality of life with acupuncture compared to sham. Key acupuncture points used include ST 25 (Tian Shu), ST 36 (Zu San Li), ST 37 (Shang Ju Xu), SP 15, CV 6 (Qi Hai) and BL 25 — selected based on the patient’s pattern. Treatment is typically weekly for 6–8 sessions.
6. Chinese herbal medicine
Formulas used:
- Ma Zi Ren Wan (Hemp Seed Pill) — the most widely used formula for constipation; addresses heat and dryness with gentle moistening laxative herbs.
- Liu Wei Di Huang Wan — for Yin deficiency with dry pellet-like stools.
- Bu Zhong Yi Qi Tang — for qi deficiency with sinking; particularly useful in elderly patients.
- Si Wu Tang — for blood deficiency causing dry stools.
- Xiao Yao San or Chai Hu Shu Gan San — for Liver qi stagnation pattern.
- Xiao Cheng Qi Tang — for excess heat with marked distension and pain.
I prescribe pharmaceutical-grade granules from Sun Ten in Taiwan, individually tailored.
7. Diet
- 30+ g fibre per day — soluble (oats, psyllium, ground flaxseed, fruit, legumes) and insoluble (vegetables, wholegrains)
- 1.5–2 litres of water daily; warm water particularly in the morning supports the Large Intestine in TCM terms
- Prunes, kiwi fruit, pears, apricots — specific evidence for constipation
- Ground flaxseed (1–2 tablespoons daily) — mild bulking laxative effect
- Olive oil — 1–2 tablespoons a day; lubricating
- Warm cooked breakfast — the Large Intestine’s peak time is 5–7am; warm food on waking supports a morning bowel movement
- Reduce constipating foods — excess red meat, cheese, refined flour products, ultra-processed food
- Reduce alcohol and caffeine — both dehydrating
8. Lifestyle and self-care
- Daily walking — 30+ minutes; the most consistently effective lifestyle intervention
- Honour the urge — do not suppress the urge to defecate; this is the most important behavioural change
- Establish a morning routine — warm water on waking, breakfast, then time to use the toilet
- Use a footstool — raises the knees above the hips, opening the anorectal angle (Squatty Potty principle)
- Abdominal massage — clockwise circular massage for 5–10 minutes daily, around the navel
- Stress management — meditation, breathwork, yoga; chronic stress slows gut motility
- Pelvic floor exercises if pelvic floor dysfunction is suspected
9. Supplements with evidence
- Magnesium (citrate or oxide, 200–400 mg) — mild osmotic laxative, well-tolerated
- Psyllium husk — the strongest fibre supplement evidence
- Probiotic — particular strains (Bifidobacterium lactis HN019) have evidence for constipation
- Vitamin C (1,000–3,000 mg) — mild osmotic effect at higher doses
- Aloe vera juice — mild laxative; not for long-term daily use
- Senna — effective stimulant laxative for short-term use only; not for long-term use
10. When to see a doctor
See your GP urgently if:
- New-onset constipation over the age of 50
- Unintentional weight loss
- Rectal bleeding (other than from haemorrhoids)
- Iron deficiency anaemia
- Family history of bowel cancer
- Severe persistent abdominal pain
- Vomiting
- Inability to pass wind (possible obstruction)
11. Frequently asked questions
How does Chinese medicine treat constipation?
Chinese medicine identifies the underlying TCM pattern (heat, qi stagnation, qi deficiency, blood deficiency, yin deficiency, yang deficiency) and treats the cause — not just the symptom. Acupuncture and individually prescribed Chinese herbal medicine restore normal bowel function rather than producing a mechanical laxative effect.
What is the best Chinese herbal formula for constipation?
The most widely used is Ma Zi Ren Wan (Hemp Seed Pill) for heat and dryness pattern. Other patterns require different formulas; treatment must be individually prescribed based on a full TCM assessment.
Can acupuncture relieve constipation?
Yes. Multiple RCTs show acupuncture significantly improves bowel frequency, stool form and quality of life in chronic constipation. It works by directly regulating colonic motility through the autonomic nervous system.
What foods help with constipation?
30+ g fibre per day, prunes, kiwi fruit, pears, ground flaxseed, oats, psyllium, plenty of vegetables, 1.5–2 litres of water, olive oil. Warm cooked breakfast on waking. Reduce red meat, cheese, ultra-processed food and alcohol.
Why am I constipated despite eating fibre?
Common reasons: inadequate water intake (fibre needs water to work), insufficient movement, chronic stress, hypothyroidism, medication side effects, pelvic floor dysfunction, or a TCM pattern (e.g. yin or blood deficiency) that fibre alone won’t address.
Are laxatives bad for you?
Short-term use is fine. Long-term daily use of stimulant laxatives (senna, bisacodyl) can desensitise the bowel and worsen function over time. The TCM approach is to restore normal motility rather than relying on stimulants.
To discuss digestive health, contact me or book a consultation at my Wokingham, Berkshire clinic.
