Systematic Arrangement Of Ancient Chinese Medical Literature Regarding Deficiency Type Constipation

ObjectiveThe overall aim of this thesis is to analyze ancient Chinese medical literature regarding the deficiency type constipation through organizing and integrating the discussed treatment cases and disease mechanisms derived at by different ancient Chinese medical doctors.A more systemized classification of disease etiology and pathogenesis,treatments and prescriptions will increase efficiency of current clinical treatment.A more in-depth understanding of the principle and pattern of the drug formula used for the deficiency type constipation in past experience could act as a reference for the syndrome differentiation and treatment.MethodsSearch and collect all the existing Chinese medical literature and classic internal medicine books related to constipation from the library.Use Zhonghuayidian to search and filter all the ancient literature containing the keyword "deficiency type constipation",read through all the articles and remove repetition and irrelevant information.Organize the remtiining literziture chronologically and use them as a reference to identify and analyze the definition of the disease,its different variations,causes,mechanisms,t reatment and prescription.Following the integration of the information,the understanding of the disease and the treatment development since ancient time,could be sorted out and compared with the relevance and efficiency of the modern conventional treatment.ResultsIn summarizing the interpretations of deficiency type constipation by different doctors,we knew that the discovery of this particular type of disease required a long observation and experience.In the meantime it had branched from the basi` type to different variations,the information regarding the causes and mechanisms had been more comprehensive through time.1.For the aspect of the mechanism of etiology and pathogenesis,it is known that the cause of constipation is mainly related to the kidney and spleen,stating "kidney opens at two yin" from HuangdiNeijing.Although there is no specific content about deficiency type constipation in Shanghanlun,it states that constipation must be differentiated to deficiency or excess type,and explains the cause of constipation could be from spleen deficiency and deficiency type of cold,and reminds doctors to take extra care of fluid during the treatment of constipation.The doctors from the Sui and Tang Dynasties agreed with the Neijing stating that kidney malfunctioning and the loss of fluid are the pathogenesis of constipation.Sun Simiao stated that deficiency type of people need to pay extra attention to lumpy stool,warned the doctors of later generation to be aware of this situation.Around Song Jin Yuan period,doctors suggested that dual deficiency of the lung-spleen,qi-blood-yin-yang disharmony,being old and weak,blood loss after labour and kidney deficiency are the factors of the deficiency type constipation,and among all the factors,the insufficiency of fluid and weak qi and blood,as well as viscera and bowels deficiency cold are the most agreed pathogenesis.Doctors from Ming and Qing Dynasties reckoned the key causes are insufficiency of fluid and weak qi and blood,and the main responsible organs are kidney,spleen and lung,and later the factor weak qi and blood had differentiated to yin deficiency and yang deficiency.Up until now,there are four main types of deficiency type constipation classified by the Chinese internal medicine-qi deficiency;blood deficiency;yin deficiency and yang deficiency.2.For the treatment aspect,there were relatively few treatment methods from the earlier time,Neijing mainly mentioned acupuncture.Zhang Zhongjing from the Eastern Han Dynasty first invented the honey suppository as a substitute to purgation as it 1s not suitable for deficiency type of people.Zhubingyuanhoulun from the Sui and Tang Dynasties clearly kstated that increasing body fluid and improving intestinal moisture level should be the main principles in treating constipation.Sun Simiao suggested medicine that moisturize the intestine and alleviate the dryness of the big intestine should be in the formula that treats constipation,and her other suggestions had contributed to the new treatment methods developed by later doctors.Doctors from the Song Jin Yuan period realized the deficiency type people can not rely on the purgation method from the past experience due to the necessity of protecting the source qi and reducing fluid loss,and switched to solely regulate qi as treatment,supplement with lubricant laxation,gradually reducing the use of purgation.More treatment methods regarding different type of the deficiency type constipation had been developed since Ming and Qing Dynasties.For the treatment targeting kidney,spleen and lung,the prescriptions tend to be warm tonification than older methods.The syndrome differentiation of deficiency type constipation continued to be more detailed and the prescriptions became more discerning,treatment specificity and flexibility increased gradually.Con1lusionThrough this research we can conclude the following few points that are agreed by most Chinese medicine doctors from the past and present:1)prioritize the care for qi and blood,carefully choose the correct type of purgation;2)fluid loss has to be monitored in all types of deficiency constipation,use lubricating medicine when appropriate;3)although the location of the disease is at large intestine,treatment should focus on regulating kidney,spleen and lung;4)considering the above 3 points the formula of the drug usage should be edited based on the patients' loss and deficiency level of the qi,blood,yin and yang.