CLINICAL APPLICATIONS

* Constipation

* Chronic, habitual constipation with dry, hard stool

* Deficient-type constipation in postpartum, postsurgical, or convalescing individuals

* Mild colon cleanser

 

WESTERN THERAPEUTIC ACTIONS

* Emollient effect to lubricate the bowel and moisten the Intestines

* Laxative effect to relieve mild to moderate constipation

* Treats chronic constipation associated with hemorrhoids by reducing inflammation

 

CHINESE THERAPEUTIC ACTIONS

* Moistens the Intestines

* Unblocks the bowels

* Drains heat

* Nourishes yin and blood

 

DOSAGE

Take 4 capsules three times daily on an empty stomach with warm water. Individuals with sensitive gastrointestinal tracts should decrease the dosage and increase the dosing frequency to avoid stomach discomfort. For example, take 2 capsules four or five times daily, instead of taking 4 capsules three times daily.

 

INGREDIENTS

Bai Shao (Radix Paeoniae Alba)

Bai Zi Ren (Semen Platycladi)

Da Huang (Radix et Rhizoma Rhei)

Dang Gui Wei (Extremitas Radix Angelicae Sinensis)

Hou Po (Cortex Magnoliae Officinalis)

Jue Ming Zi (Semen Cassiae)

Ku Xing Ren (Semen Armeniacae Amarum)

Mai Dong (Radix Ophiopogonis)

Tao Ren (Semen Persicae)

Xuan Shen (Radix Scrophulariae)

Yu Li Ren (Semen Pruni)

Zhi He Shou Wu (Radix Polygoni Multiflori Praeparata)

Zhi Shi (Fructus Aurantii Immaturus)

 

BACKGROUND

Constipation is the infrequent or incomplete passage of stools. The stools are usually dry and hard, and are difficult to pass even with straining. Individuals with constipation often have two or fewer bowel movements per week, and will usually have feelings of incomplete evacuation after bowel movement. Common causes of constipation include lack of exercise, insufficient intake of water and fiber, stress, overuse of laxatives, and use of certain drugs (including opioids, antipsychotics, antidepressants, and anticholinergics).

 

FORMULA EXPLANATION

Gentle Lax (Deficient) is a mild formula suitable for deficient-type constipation. Deficient-type constipation is defined as chronic or habitual constipation, constipation in geriatric patients, or constipation in patients with red tongue, pale or sallow face, and general signs and symptoms of weakness.

        Yu Li Ren (Semen Pruni) and Bai Zi Ren (Semen Platycladi) moisten the Intestines and unblock the bowels. Ku Xing Ren (Semen Armeniacae Amarum) and Tao Ren (Semen Persicae) lubricate the Large Intestine and direct qi downward. Zhi Shi (Fructus Aurantii Immaturus) and Hou Po (Cortex Magnoliae Officinalis) dissipate stagnation and reduce distension and bloating. Xuan Shen (Radix Scrophulariae) and Mai Dong (Radix Ophiopogonis) clear heat, cool the blood and nourish the yin. Bai Shao (Radix Paeoniae Alba) nourishes blood and relieves pain, which may be associated with constipation. Da Huang (Radix et Rhizoma Rhei) is a purgative that clears toxic heat lodged in the Intestines. Jue Ming Zi (Semen Cassiae) moistens the Intestines and facilitates the passage of stools. Dang Gui Wei (Extremitas Radix Angelicae Sinensis) and Zhi He Shou Wu (Radix Polygoni Multiflori Praeparata) enrich blood and act as gentle laxatives by moistening the desiccated intestines.

 

CAUTIONS & CONTRAINDICATIONS

* Individuals with a sensitive gastrointestinal tract should take this formula with caution, as it may be irritating to the stomach and intestinal mucosa. Those who experience stomach discomfort should reduce the dosage and take the herbs with food.

* A more serious etiology should be suspected if the constipation is accompanied by vomiting, blood in the stools, weight loss, or a distended, tympanitic abdomen.

* This formula is contraindicated during pregnancy and nursing.

* This herbal formula contains herbs that invigorate blood circulation, such as Dang Gui Wei (Extremitas Radix Angelicae Sinensis). Therefore, patients who are on anticoagulant or antiplatelet therapies, such as Coumadin (warfarin), should use this formula with caution, or not at all, as there may be a higher risk of bleeding and bruising.[1]^,[2],[3]

* The following warning statement is required by the State of California: ¡§This product contains Da Huang (Radix et Rhizoma Rhei). Read and follow directions carefully. Do not use if you have or develop diarrhea, loose stools, or abdominal pain because Da Huang (Radix et Rhizoma Rhei) may worsen these conditions and be harmful to your health. Consult your physician if you have frequent diarrhea or if you are pregnant, nursing, taking medication, or have a medical condition.¡¨

* According to most textbooks and contemporary references, the classic entry of "He Shou Wu" is now separated into two entries: the unprepared Sheng Shou Wu (Radix Polygoni Multiflori) and the prepared Zhi He Shou Wu (Radix Polygoni Multiflori Praeparata), as they have significantly different therapeutic effects and side effects. Sheng Shou Wu (Radix Polygoni Multiflori) is a stimulant laxative that treats constipation, but may cause nausea, vomiting, abdominal pain, diarrhea, and in rare cases, liver disorder (dose- and time-dependent, and reversible upon discontinuation).[4] On the other hand, Zhi He Shou Wu (Radix Polygoni Multiflori Praeparata) is a tonic herb that is safe and well-tolerated. The dramatic changes in the therapeutic effect and safety profile are attributed to the long and complicated processing of the root with Hei Dou (Semen Sojae) through repeated blending, cooking, and drying procedures. When properly processed, the chemical composition of the root changes significantly. Many new compounds are generated from the Maillard reaction (four furanones, two furans, two nitrogen compounds, one pyran, one alcohol and one sulfur compound). Furthermore, the preparation process causes changes in the composition of sugars and 16 kinds of amino acids; it also reduces the pH of the herb from 6.28 to 5.61.[5],[6]^,[7] In summary, these changes give rise to the tonic effects of the prepared roots, and eliminate the adverse reactions associated with the unprepared roots. Note: Due to medical risks and legal liabilities, it is prudent to exercise caution and not use this herb in either prepared or unprepared forms in patients with pre-existing or risk factors of liver diseases.

 

CLINICAL NOTES

* Use of herbs is very effective to prevent drug-induced constipation. There are two types of drugs that are most likely to cause constipation: opioids [i.e., Vicodin (hydrocodone/acetaminophen), Darvocet (propoxyphene/acetaminophen), Tylenol/Codeine (acetaminophen/codeine)] and antipsychotic drugs [i.e., Haldol (haloperidol), Thorazine (chlorpromazine)].

 

Pulse Diagnosis by Dr. Jimmy Wei-Yen Chang:

* Constipation due to constriction: Yinqiao pulse, a thin, straight, wiry pulse on or extends proximal to the left chi

* Constipation due to dryness in the Stomach and Large Intestine: floating and forceful on the right cun and guan

 

SUPPLEMENTARY FORMULAS

* For excess types of constipation, use Gentle Lax (Excess).

* To detox the colon, use GI DTX instead.

* For constipation due to stress, add Calm.

* For gastrointestinal disorders such as acid reflux or ulcers, use GI Care instead.

* For irritable bowel syndrome (IBS), use GI Harmony instead.

* For ulcerative colitis, use GI Care (UC) instead.

* For hemorrhoids and pain, use GI Care (HMR) and Herbal ANG instead.

* To tonify blood, combine with Schisandra ZZZ.

* For constipation due to neurodegenerative disorders, Alzheimer¡¦s, Parkinson¡¦s and stroke, use Neuro Plus.

* With excess fire, add Gardenia Complex.

* For rectal bleeding, add Notoginseng 9.

* For severe blood stagnation, add Circulation (SJ).

* For constipation in postpartum women with deficiency, add Imperial Tonic.

* For constipation and postpartum depression, add Shine.

 

ACUPUNCTURE TREATMENT

Traditional Points:

* Zhigou (TH 6), Zhaohai (KI 6)

* Qihai (CV 6), Zhongwan (CV 12), Geshu (BL 17), Renzhong (GV 26), Zhigou (TH 6), Tianshu (ST 25), Taichong (LR 3), Zusanli (ST 36), Dachangshu (BL 25)

 

Classic Master Tung's Points:

* Constipation (general): Tushui (T 22.11), Qimen (T 33.01), Qijiao (T 33.02), Qizheng (T 33.03), Simashang (T 88.18), Simazhong (T 88.17), Simaxia (T 88.19), Tongtian (T 88.03), Fuchang (T 77.12), Huochuan (T 33.04)

* Constipation (post-partum): Simashang (T 88.18), Simazhong (T 88.17), Simaxia (T 88.19)

 

Master Tung¡¦s Points by Dr. Chuan-Min Wang:

* Constipation: Shuitong (T 1010.19), Shuijin (T 1010.20), Shuizhong (T DT.13), Shuifu (T DT.14)

 

Balance Method by Dr. Richard Tan:

* Left side: Waiguan (TH 5), Zhigou (TH 6), Zhaohai (KI 6), Hegu (LI 4)

* Right side: Zusanli (ST 36), Shangjuxu (ST 37), Kongzui (LU 6) or ah shi points nearby

* Left and right sides can be alternated from treatment to treatment.

 

Ear Acupuncture:

* Large Intestine, Colon, Rectum, Sympathetic. Tape magnetic balls onto the points and switch ears every three days. If both ears are taped at the same time, rest one day in between the three-day treatments.

* Large Intestine, Rectum. Strong stimulation is necessary two or three times daily. Leave the needles in for one hour. Embed ear seeds in Spleen, Large Intestine and Rectum. Switch ear every week.

 

Auricular Medicine by Dr. Li-Chun Huang:

* Abdomen, Spleen, Lung, Liver, San Jiao, Large Intestine, Sigmoid, Digestive Subcortex

 

NUTRITION

* Eat plenty of foods with high fiber, such as fresh fruits, green leafy vegetables, cabbage, peas, sweet potatoes, and whole grains.

* Drink plenty of water, at least eight glasses per day.

* Prunes or prune juice are very effective to regulate bowels and relieve mild cases of constipation.

* A combination of wild or raw honey with fresh grapefruit will also relieve dry stool or constipation.

* Black sesame with wild honey is a helpful combination to soften stool and facilitate bowel movement.

* Increase intake of nourishing, cooling foods/roots such as Mexican yam, yam, radishes, potatoes, carrots, melons, cucumbers, beets, turnips, malanga, celeriac, taro, and rutabaga.

* Avoid deep-fried foods. Follow a low-fat diet.

* Avoid fatty and spicy foods that may irritate the mucous membranes of the intestines.

* Avoid spicy/pungent/aromatic vegetables such as pepper, garlic, onions, basil, rosemary, cumin, funnel, anise, leeks, chives, scallions, thyme, saffron, wormwood, mustard, chili pepper, and wasabi.

 

The Tao of Nutrition by Dr. Maoshing Ni and Cathy McNease:

* Recommendations: bananas, apples, walnuts, figs, spinach, peaches, pears, pine nuts, sesame seeds, mulberries, grapefruit, yams, honey, apricot kernel, milk, yogurt, alfalfa sprouts, beets, cabbage, bok-choy, cauliflower, and potato.

* Eat two bananas on an empty stomach, followed by a glass of water.

* Drink a glass of lukewarm water with two teaspoons of honey on an empty stomach.

* Drink blended beets and cabbage on an empty stomach.

* Eat 5 to 10 figs on an empty stomach, followed by a glass of water.

* Eat a fresh apple on an empty stomach daily.

* Drink mulberry juice.

* Eat lightly steamed asparagus and cabbage at night before retiring.

* Avoid spicy foods, fried foods, and meat.

 

LIFESTYLE INSTRUCTIONS

* Avoid stress, anxiety and tension whenever possible.

* Exercise regularly to increase peristalsis of the intestines. Walking is one of the best exercises as it massages the intestines to regulate the bowels.

* Do not suppress the urge to relieve the bowels. Suppressing the urge is one of the main causes of chronic constipation. Empty the bowels whenever there is a desire, especially in the morning when the digestive system is most active.

* Massaging the abdomen along the directional flow of the large intestine (clock-wise) will also help.

* Patients with hemorrhoids should not lift anything heavy.

 

CASE STUDIES

* J.J., a 49-year-old female, presented with constipation and abdominal bloating. The patient had a history of having a bowel movement every other day to every three days since childhood. She was experiencing cold sensation and had been taking birth control pills for heavy bleeding. As a result of taking birth control pills, she would experience night sweats when she was taking the sugar pills or during her menses. Her blood pressure was 118/72 mmHg and her heart rate was 75 beats per minute. The practitioner diagnosed this condition as yin deficiency and stagnation; the Western diagnosis was chronic constipation. Gentle Lax (Deficient) was prescribed at three pills three times daily with warm water in combination with Balance (Heat) three to five capsules at night when she is not taking birth control pills. The patient was amazed with the results; she reported having regular daily bowel movements and relief of her bloating. In addition, she was no longer experiencing night sweats when she was on the sugar pill days of her birth control pills pills. Along with taking herbs the patient also received acupuncture twice weekly. Submitted by L.W., Arroyo Grande, California.

* A 32-year-old female presented with chronic constipation, which started since her early teens. Her bowel movements had occurred every three to four days. The practitioner diagnosed her condition as Spleen qi deficiency. After taking Gentle Lax (Deficient), her bowel movements became daily and regular. She noted that using Gentle Lax (Deficient) did not cause a feeling of fullness. After two months, her bowel movements have maintained a regular and daily schedule. Submitted by S.T., San Jose, California.

* A 49-year-old female teacher presented with constipation and gas as her chief complaints. Other signs and symptoms included bloating, low back pain, stress, anger, irritability, and fatigue. Her overall condition was indicative of irritable bowel syndrome. The practitioner attributed the patient¡¦s constipation and gas to Liver qi stagnation. The patient was previously treated with a combination of Xiao Yao San (Rambling Powder) and Ma Zi Ren Wan (Hemp Seed Pill) with little success. Once the practitioner substituted Gentle Lax (Deficient) and GI Care, the patient¡¦s chief complaints abated. Her stress level lessened as well. Submitted by D.M., Raton, New Mexico.

* F.L., a 53-year-old female patient, presented with recent history of TIA (transient ischemic attack). Objective findings included right-sided pulling and numbness of the face with difficulty smiling and closing the right eye, as well as drooping of facial muscles on the right side when smiling, and partial facial flaccidity. Treatment using three capsules of Circulation, three times daily, was successful: no recurring episodes were noted during subsequent follow-up visits. This patient also had constipation with hard, difficult to move stools, abdominal pain, and cramps with bloating. All these gastrointestinal symptoms were resolved with Gentle Lax (Deficient) taken at four capsules, three times daily. Submitted by C.L., Chino Hills, California.

* J.N., a 68-year-old male patient, presented with constipation and bloating. His blood pressure was 176/86 mmHg and the heart rate was 54 beats per minute. The practitioner diagnosed him with constipation and bloating due to blood deficiency, dryness, and from side effects of the high blood pressure medications. Gentle Lax (Deficient) was prescribed at 2 grams three times daily. Acupuncture was also given to balance the system. Patient reported that the formula helped him go to the bathroom daily and that it took less effort to pass stools. Submitted by W.F., Bloomfield, New Jersey.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

Gentle Lax (Deficient) is composed of herbs with mild laxative functions to promote regular bowel movements in individuals who have chronic or habitual constipation.

        Pharmacologically, many of these herbs have excellent laxative, purgative, and lubricant effects. Da Huang (Radix et Rhizoma Rhei) has direct laxative and purgative effects to quickly and powerfully treat constipation.[8] Da Huang (Radix et Rhizoma Rhei) works mainly on the transverse and descending colon as it inhibits the re-absorption of water and causes evacuation of the stool.[9]^,[10] In addition, Da Huang (Radix et Rhizoma Rhei) increases peristalsis of the large intestine without interfering with absorption of nutrients in the small intestine.[11] Furthermore, Yu Li Ren (Semen Pruni) increases peristalsis and promotes bowel movement.[12] Bai Zi Ren (Semen Platycladi) has a mild effect to lubricate the bowel and relieve constipation.[13] Zhi Shi (Fructus Aurantii Immaturus) stimulates smooth muscle and increases intestinal peristalsis.[14]

        Clinically, herbs in this formula have been used successfully to treat chronic constipation, habitual constipation, and constipation with bloating. According to one study, 50 elderly patients with chronic constipation were treated with a 94% rate of effectiveness. [15] According to another study, 60 patients with chronic habitual constipation were treated with great success using herbs such as Bai Shao (Radix Paeoniae Alba), Gan Cao (Radix et Rhizoma Glycyrrhizae), and others as needed. [16] Furthermore, use of Jue Ming Zi (Semen Cassiae) as tea throughout the day also showed a marked effect to relieve chronic constipation.[17] Lastly, administration of Hou Po (Cortex Magnoliae Officinalis) in 36 women greatly reduced incidence of constipation and abdominal bloating following surgery.[18]

        In summary, Gentle Lax (Deficient) is excellent for chronic or habitual constipation of mild to moderate severity.

 

COMPARATIVE ANALYSIS

Constipation is a very common problem that may be treated effectively using Western and traditional Chinese medicines. In Western medicine, bulking agents (bran, psyllium, and methylcellulose) are the gentlest and safest. These drugs are not habit forming, and may be used safely on a long-term basis. However, they act slowly and are not very strong. Laxatives (docusate and mineral oil) soften the stool by increasing the implementation of intestinal water. However, these drugs must be used carefully, as they interfere with the absorption of nutrients and other drugs. Lastly, cathartics (senna, cascara, and bisacodyl) are used for severe cases of constipation by increasing intestinal peristalsis and intraluminal fluids. However, these drugs should only be used on a short-term basis, as prolonged use will cause ¡§lazy bowel¡¨ syndrome and serious fluid and electrolyte imbalance.

        Constipation is treated with great success in TCM. Those with mild to moderate constipation are usually treated with herbs that moisten the Intestines and regulate bowel movement. Those with moderate to severe constipation are generally treated with herbs that purge the Intestines and induce bowel movement. These formulas should be used as needed, and discontinued when desired effects are achieved. Herbal formulas that contain Da Huang (Radix et Rhizoma Rhei) should be taken with meals, as it may irritate the stomach if taken on an empty stomach. Prolonged use of formula with Da Huang (Radix et Rhizoma Rhei) is not recommended, as it may increase the risk of habitual constipation and fluid and electrolyte imbalance.

        Both drugs and herbs are equally effective in treating constipation. Both modalities of medicines should be used sparingly, and when needed, as prolonged use may cause side effects. Once a bowel movement is induced, herbal therapy may be initiated to change the fundamental constitution of the body in those with habitual constipation. Lastly, diet and lifestyle adjustments are also needed to ensure regular bowel movement.