A 34-year-old woman with a one-month history of functional constipation, severe irritability, and insomnia was managed using an organ-regulating herbal strategy without relying on harsh purgatives.

Case ID: CHC-0024

Case Summary

This case describes a 34-year-old woman who presented with a one-month history of difficult, infrequent bowel movements accompanied by headaches, poor sleep, and emotional distress. The original report documented a Western medical diagnosis of functional constipation and a TCM assessment of Liver Qi stagnation, Spleen deficiency, and internal Damp-Heat. The patient was managed using a complex herbal prescription designed to soothe the Liver, strengthen the digestive system, and clear internal heat, restoring bowel function by harmonizing the body’s entire internal environment.

Patient Presentation

• Patient: 34-year-old female.
• Main Complaint: Dry, hard stools with bowel movements occurring only once every 4 to 5 days over the past month.
• History: The patient reported a sudden onset of severe constipation approximately one month prior to the consultation on July 13, 2023. This was accompanied by bilateral headaches, marked irritability, and significant sleep disturbances (difficulty falling asleep, easily awakened, yielding only 4 to 5 hours of sleep per night). After eating, she frequently experienced abdominal distension and nausea. Her menstrual cycle was regular, but the menstrual blood was scanty and dark.

Examination and Diagnosis

• Conventional Diagnosis: Functional constipation.
• TCM Tongue and Pulse (Initial Visit): The tongue was pale with teeth marks on the edges and covered by a white, greasy coating. The pulse was stringy and slippery (弦滑).

TCM Assessment

The original practitioner interpreted the presentation as Constipation driven by Liver Qi stagnation, Spleen deficiency, and internal Damp-Heat accumulation (肝郁脾虚，湿热内蕴).

According to the holistic principles of yin and yang Chinese Medicine, normal bowel function depends entirely on a balanced internal organ environment rather than just the physical colon. In this patient, chronic emotional stress or frustration caused her Liver Qi to stagnate, leading to her irritability and headaches. This stagnant Liver energy then “overacted” on her Spleen and Stomach, causing the post-meal nausea and distension.

The resulting Spleen deficiency impaired fluid metabolism, allowing internal dampness to accumulate (objectively confirmed by the pale tongue with teeth marks and a white, greasy coating). Over time, the trapped Qi and dampness generated internal heat, which scorched the intestinal fluids and dried out the stool. Furthermore, this ascending stagnant heat harassed the Heart and Mind, causing her persistent insomnia.

Treatment Approach

The primary treatment principle was to soothe the Liver and resolve depression, strengthen the Spleen to transform dampness, and clear heat to calm the spirit (疏肝解郁，健脾化湿，清热安神). The practitioner specifically avoided the use of aggressive laxatives, opting instead to repair the functional pathways of the five Zang organs to naturally restore intestinal motility.

Herbal Formulas and Modifications

• Initial Formula (July 13, 2023): The practitioner prescribed a modified combination of two classical formulas: Danzhi Xiaoyao San (Moutan and Gardenia Free Wanderer Powder) and Zhizhu Wan (Immature Bitter Orange and Atractylodes Pill).
  • Clearing Heat and Cooling Blood: Mu Dan Pi (15g) and Chao Zhi Zi (10g) were used to clear the trapped heat and cool the blood. Sheng Shi Gao (15g) was added to powerfully clear excess Stomach fire.
  • Soothing Liver and Regulating Qi: Chai Hu (15g), Huang Qin (10g), and Xiang Fu (10g) were utilized to soothe the stagnant Liver Qi and relieve the emotional distress. Chao Bai Shao (15g) nourished the blood and softened the Liver.
  • Strengthening Spleen and Resolving Dampness: Bai Zhu (15g), Fu Ling (20g), and Ze Xie (15g) fortified the digestive system and safely drained the excess dampness.
  • Regulating the Qi Dynamic: Zhi Shi (10g) was paired with Jie Geng (20g). This specific pairing works by ascending the Lung Qi (Jie Geng) and descending the Stomach/Intestinal Qi (Zhi Shi), physically restoring the body’s vertical energy flow to encourage bowel movements. Gan Cao (10g) harmonized the decoction.
• Modification (Second Visit – July 20, 2023): After the initial course, the patient reported mild pain during urination, indicating that the damp-heat had shifted to the lower jiao (pelvic region). The practitioner removed Xiang Fu and added Mu Xiang (10g) and Jiang Hou Po (10g) to further enhance Qi movement and relieve remaining distension. Ge Gen (30g) and Dan Zhu Ye (15g) were added specifically to clear the lower jiao damp-heat, generate fluids, and relieve the urinary discomfort.

Follow-Up

• July 20, 2023 (Second Visit): After consuming six doses of the daily decoction, the source reported a marked improvement. The patient’s bowel movements increased in frequency to once every 2 to 3 days, and her stool returned to a normal consistency. Her abdominal distension and emotional irritability were significantly relieved, and her appetite normalized. Her tongue presentation shifted to a red tongue with a thin yellow coating and a stringy pulse, prompting the formula adjustment to consolidate the treatment and address the mild urinary pain.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the classical approach to treating functional constipation. Modern patients often rely heavily on stimulant laxatives or heavy doses of Da Huang (Rhubarb) for quick relief. However, as the original report’s editorial notes highlight, the ancient text Zhubing Yuanhou Lun (Treatise on the Causes and Manifestations of Diseases) states: “Difficulty in defecation is due to disharmony of the five Zang organs…”

The original practitioner recognized that the constipation was merely a branch symptom of a much larger systemic breakdown involving the Liver (stress) and Spleen (poor digestion). By choosing to gently untangle the Liver Qi, drain the dampness, and re-establish the ascending/descending mechanics of the torso (using Jie Geng and Zhi Shi), the treatment successfully restored natural bowel function without ever relying on harsh purgative herbs, effectively addressing both the physical blockage and the patient’s severe emotional distress simultaneously.

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What This Case Can — and Cannot — Tell Us

This is an individual case report, not a controlled clinical trial. It documents the reasoning, treatment, and outcome reported for one patient and should not be interpreted as evidence that the same approach will produce the same result in another person.

Source

• Original source: Beijing University of Chinese Medicine Shenzhen Hospital (Longgang) / Guangdong Provincial Administration of Traditional Chinese Medicine
• Original title: 【以案说医】王进东：气郁湿结排便难，五脏通调病自安
• Practitioner: Professor Wang Jindong (王进东)
• Publication date: October 18, 2024
• Original language: Chinese
• Source link: View original page
• ChineseHerb.org version: English translation and editorial adaptation