expels internal Cold from the Intestines. This formula is therefore suitable for a combination of
Cold obstructing the Intestines with a background of Kidney-Yang deficiency.

Prognosis

Both acupuncture and Chinese herbs are very effective in the treatment of constipation.
However, chronic constipation may take a long time to be cured. The more long-standing it is,
and the more the patient has resorted to laxatives, the longer it will take to cure. Thus, one
should not be surprised if a case of chronic constipation of over 10 years' duration takes more
than 1 year to be cured.

Western Differentiation

There is no Western medical differentiation of constipation as such, as it is considered a
symptom rather than a "disease". In our practice, the main possibilities to keep in mind are acute
appendicitis and intestinal obstruction in acute constipation, and bowel carcinoma in chronic
constipation.

Acute Appendicitis

(See also "Abdominal pain", Chapter 16.)

This usually presents with an umbilical pain which gradually moves and settles on the
McBurney's point on the right iliac fossa. There is also vomiting, foul breath and constipation.
However, it must be emphasized that constipation is not an absolutely distinguishing sign of
acute appendicitis as this may also present with diarrhoea.

Intestinal Obstruction

At all ages adhesions and hernias are common causes of obstruction. In children, intussusception
is a frequent cause. This consists in the prolapse of one part of the intestine into the lumen of an
immediately adjacent part. In the elderly a volvulus (the torsion of a loop of intestine) or tumour
are the most likely causes.

Bowel cancer is the second most frequent cancer in men over 50 after lung cancer. It may
present with either constipation or diarrhoea. In any case, it is characterized by a fairly sudden
change of bowel habit, blood in the stools, and abdominal pain (see also "Abdominal pain",
Chapter 16).