Developing diagnosis and treatment strategies for functional constipation from the perspective of the liver's"using bitter herbs to nourish or purge"via"liver communicates with the large intestine"
10.3969/j.issn.1006-2157.2025.08.010
- VernacularTitle:肝"苦欲补泻"视角下从"肝与大肠相通"构建功能性便秘辨治思路
- Author:
Bowen ZHANG
1
;
Zichen LYU
;
Yunlong LIU
;
Rongkun XUE
;
Xiaohui YU
;
Sihan LI
;
Shengwei GAO
;
Yuhong HUANG
;
Xinping PENG
;
Jiting LI
Author Information
1. 天津中医药大学 天津 301617;天津中医药大学第二附属医院临床药理中心
- Publication Type:Journal Article
- Keywords:
using bitter herbs to nourish or purge;
liver communicates with the large intestine;
functional constipation;
Huangdi Neijing
- From:
Journal of Beijing University of Traditional Chinese Medicine
2025;48(8):1121-1126
- CountryChina
- Language:Chinese
-
Abstract:
Based on the theory of the liver's"using bitter herbs to nourish or purge"from Huangdi Neijing,this paper systematically elucidates the theoretical foundation for treating functional constipation from liver.Focusing on the physiological characteristic of"liver desires to disperse"and the pathological manifestation of"liver bitterness and urgency,"combined with the"liver communicates with the large intestine"theory,this paper establishes a diagnostic and therapeutic framework for managing functional constipation by regulating liver function.The pathological evolution of functional constipation manifests in three distinct stages:in the early stage,liver qi stagnation leads to large intestine qi obstruction,where damaged by an excess of seven emotions resulting in symptoms such as difficult defecation,abdominal bloating,and hypochondriac pain;in the middle stage,liver depression transforms into fire,scorching bodily fluids to generate dryness,thereby creating a pathological interplay of stagnation,fire,and dryness,which is marked by anal heat,dry mouth,and yellow urine;in the late stage,yin deficiency in liver and kidney causes large intestine malnutrition,resulting in a complex pathological state where yin deficiency,collateral blockage,dryness accumulation,and blood stasis intertwine,clinically manifesting as pellet-like stools(resembling sheep feces)and soreness and weakness of the waist and knees.In treatment,the formula design follows the principle of"sweetness to relieve,acridity to tonify,and sourness to purge,"with treatment principles varying across stages.In the early stage,the focus is on dispersing liver and regulating qi,and unblocking the zang-fu viscera;in the middle stage,the priority shifts to clearing heat-fire,nourishing large intestine,and promoting fluid production;whereas,in the late stage,the emphasis lies on nourishing yin,unblocking collaterals,and promoting blood circulation.This staged treatment of functional constipation overcomes the limitations of solely focusing on nourishing large intestine and facilitating feces excretion,thereby advancing the treatment of different stages based on syndrome differentiation and personalized treatment.It provides theoretical support for improving patients' intestinal function and enhancing overall health outcomes.
