Constipation in elderly patients is generally attributable to reduced physical activity, impaired mastication, consumption of low-residue foods, and insufficient intake of fiber-rich fruits and vegetables. Combined with age-related qi deficiency, irregular bowel habits develop over time, eventually progressing to chronic habitual constipation.
Traditional Chinese Medicine (TCM) attributes constipation in the elderly to qi deficiency with intestinal atony. In such cases, cathartic or purgative agents are contraindicated, as they risk further debilitating the patient. The preferred therapeutic approach is the classical formula known as “Geng Yi Wan” (更衣丸):
Composition: 肉蓯蓉 Rou Cong Rong (Cistanche) 20g, 黑芝蔴 Hei Zhi Ma (black sesame) 30g, 厚朴 Hou Po (Magnolia bark) 6g, 枳實 Zhi Shi (aurantii immaturus) 6g, 柏子仁 Bai Zi Ren (Platycladi semen) 12g, 黨蔘 Dang Shen (Codonopsis) 20g, 木香 Mu Xiang (Aucklandiae radix) 3g. Decocted in water for oral administration.
This formula addresses qi-deficient intestinal atony by lubricating the intestines and promoting bowel transit. The recommended dosage is three to four decoctions per month, administered one to two times weekly, with satisfactory clinical outcomes expected. By tonifying qi and moistening the intestines, the formula supports improvement of overall constitution.
It should also be noted that constipation may represent an early symptom of an underlying pathology. In elderly patients presenting with constipation or progressively narrowing stool caliber, colorectal carcinoma should be the primary differential diagnosis. Benign prostatic hyperplasia causing urinary retention may also contribute to defecatory difficulty. Diabetes mellitus and hypothyroidism are among the systemic conditions that may cause constipation, and clinical evaluation by a physician is recommended for confirmation. That said, Geng Yi Wan may provide symptomatic relief and remains applicable even in these patient populations.
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