Chronic constipation

The following is a case history sent by Jason Smith, a practitioner in Spain.

A 37-year-old woman complained of chronic constipation. She has a bowel movement every 3 days and the problem is aggravated by emotional stress (she works in a lawyer’s office and she finds the work stressful). Occasionally, the bowel movements increase in frequency and she may even go 3 times in one day. The stools are hard and dry.

In the past two months, she developed a distending pain in the abdomen every time she eats. She has a feeling of the food not going down which causes her breathlessness. She has a burning sensation in the epigastrium.

She has abdominal distension after eating, feels sleepy after eating and has a very slow and difficult digestion.

Feels very irritable and feels like crying before the period. She says she feels like crying but is unable to. She reports being very frustrated by her job. She occasionally has a feeling of lump in the throat. Twice she had pain in the coastal region.

At night she experiences tingling and numbness of her legs. She says her memory is bad. She goes through periods of insomnia (both difficulty in falling asleep and waking up in the middle of the night); her periods are very scanty periods and her nails brittle. The periods comes regularly every 32 days and last four days; there are some dark clots but no pain.

She has occasionally a throbbing headache on the temple and behind the eye when stressed at work. Her hair falls out (she says this occurs during the change from spring to summer and summer to autumn).

Her tongue is very thin, slightly reddish purple (especially on the sides) with a yellow rootles coating that is thicker on the root. The tip is very red.


Diagnosis
The patterns involved are Liver-Qi stagnation (constipation, distending pain, costal pain, feeling of lump in throat) as well as Spleen-Qi deficiency and Dampness in the digestive system (difficult digestion, sleepy after eating, yellow coating thicker on the root).

There is also Liver-Blood deficiency (scanty periods, hair falling out, brittle nails, insomnia). The Blood deficiency occasionally gives rise to Liver-Yang rising causing the throbbing headaches.
There is also some Liver-Blood stasis (purpe tongue, dark clots), but this is not a major pattern.

The rootless coating also shows some Stomach-Yin deficiency which causes the burning feeling in the epigastrium.

The pulse is not Wiry which indicates that the Liver-Qi stagnation is secondary to the Liver-Blood deficiency.

There are the interesting symptoms reported of abdominal distension with a feeling of the food not going down which causes her breathlessness: I attribute these symptoms to rebellious Qi of the Chong Mai.


Treatment
She was treated with acupuncture and some Three Treasures and Women´s Treasure remedies. She was prescribed Smooth Passage (morning) to treat the three patterns of Liver-Qi stagnation, Spleen-Qi deficiency and Dampness, and Central Mansion (afternoon) to nourish Stomach-Qi and Stomach-Qi and resolve Dampness. These two remedies were taken every day. Freeing the Moon was added during phase 4.

Two weeks after taking the remedies the bowel movements started occurring on a daily basis, with the stools returning to a normal consistency. Over the following weeks, the patient reported feeling much better and more relaxed on a mental-emotional level, and without any feeling of lump in the throat, reacting "normally under stressful conditions". One month later, the bowel movements where back to normal and she reported feeling "very well, as I hadn´t felt in years." Treatment still is being conducted.